QT interval evaluation associated with the use of hydroxychloroquine with combined use of azithromycin among hospitalised children positive for coronavirus disease 2019

Tunçer, Tunç; Karacı, Mehmet; Boğa, Aysun; Durmaz, Hilal; Güven, Şirin

doi:10.1017/s1047951120002425

Cited by 11 publications

(10 citation statements)

References 13 publications

(11 reference statements)

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“…The potential role of pharmacological treatments such as hydroxychloroquine (HCQ) and azithromycin in enhancing the susceptibility to QT-related life-threatening ventricular arrhythmias, particularly Torsades de pointes (TdP), is increasingly recognized in adults[ 147 - 149 ]. Nevertheless, pediatric observations have shown that these drugs are safe in previously healthy children[ 150 ].…”

Section: Resultsmentioning

confidence: 99%

“…Early in the pandemic, concerns have appeared about the potential of pro-arrhythmic events due to the use of prolonging-qt drugs that have raised, particularly the combined use of chloroquine (CQ), HCQ and azithromycin[ 147 - 149 , 191 , 192 ]. The authors of a small single-center, the retrospective study found no risk of QT prolongation or TdP in children with COVID-19 under treatment with HCQ[ 150 ]. However, the patients included were not severely affected by the disease, and none of them required intensive care, had cardiovascular comorbidity, and were taking corrected QT-prolonging medications, nor had ionic alterations.…”

Section: Resultsmentioning

confidence: 99%

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Cardiovascular impact of COVID-19 with a focus on children: A systematic review

Rodríguez-González

Castellano-Martínez

Cascales-Poyatos³

et al. 2020

WJCC

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BACKGROUND Since the beginning of the pandemic, coronavirus disease-2019 (COVID-19) in children has shown milder cases and a better prognosis than adults. Although the respiratory tract is the primary target for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), cardiovascular involvement is emerging as one of the most significant and life-threatening complications of SARS-CoV-2 infection in adults. AIM To summarize the current knowledge about the potential cardiovascular involvement in pediatric COVID-19 in order to give a perspective on how to take care of them during the current pandemic emergency. METHODS Multiple searches in MEDLINE, PubMed were performed using the search terms “COVID-19” or “SARS-CoV-2" were used in combination with “myocardial injury” or "arrhythmia" or “cardiovascular involvement” or "heart disease" or "congenital heart disease" or “pulmonary hypertension” or "long QT" or “cardiomyopathies” or “channelopathies” or "Multisystem inflammatory system" or "PMIS" or “MIS-C” or ”Pediatric multisystem inflammatory syndrome" or "myocarditis" or "thromboembolism to identify articles published in English language from January 1st, 2020 until July 31st, 2020. The websites of World Health Organization, Centers for Disease control and Prevention, and the Johns Hopkins Coronavirus Resource Center were reviewed to provide up to date numbers and infection control recommendations. Reference lists from the articles were reviewed to identify additional pertinent articles. Retrieved manuscripts concerning the subject were reviewed by the authors, and the data were extracted using a standardized collection tool. Data were subsequently analyzed with descriptive statistics. For Pediatric multisystemic inflammatory syndrome temporally associated with COVID-19 (PMIS), multiple meta-analyses were conducted to summarize the pooled mean proportion of different cardiovascular variables in this population in pseudo-cohorts of observed patients. RESULTS A total of 193 articles were included. Most publications used in this review were single case reports, small case series, and observational small-sized studies or literature reviews. The meta-analysis of 16 studies with size > 10 patients and with complete data about cardiovascular involvement in children with PMIS showed that PMIS affects mostly previously healthy school-aged children and adolescents presenting with Kawasaki disease-like features and multiple organ failure with a focus on the heart, accounting for most cases of pediatric COVID-19 mortality. They frequently presented cardiogenic shock (53%), ECG alterations (27%), myocardial dysfunction (52%), and coronary artery dilation (15%). Most cases required PICU admission (75%) and inotropic support (57%), with the rare need for extracorporeal membrane oxygenation (4%). Almost all of these children wholly recovered in a few days, although rare deaths have been reported (2%). Out of PMIS cases we ide...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Cardiovascular impact of COVID-19 with a focus on children: A systematic review

Rodríguez-González

Castellano-Martínez

Cascales-Poyatos³

et al. 2020

WJCC

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“…Prolongation of the QTc interval can predispose patients to malignant ventricular arrhythmias including torsade de pointes [ 8 , 9 ]. In an effort to quantify the degree of QTc prolongation and the associated events of ventricular arrhythmias and torsade de pointes in patients with COVID-19 who were treated with hydroxychloroquine with and without azithromycin, multiple studies were published globally [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Our objective with this study was to systematically review the available literature, examining the association between the use of hydroxychloroquine with or without azithromycin in hospitalized patients with COVID-19 and QTc prolongation, as well as the incidence of ventricular arrhythmias and torsade de pointes.…”

Section: Introductionmentioning

confidence: 99%

Effect of Hydroxychloroquine on QTc in Patients Diagnosed with COVID-19: A Systematic Review and Meta-Analysis

Arfaras-Melainis

Tzoumas

Kokkinidis

et al. 2021

JCDD

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Background: Hydroxychloroquine or chloroquine with or without the concomitant use of azithromycin have been widely used to treat patients with SARS-CoV-2 infection, based on early in vitro studies, despite their potential to prolong the QTc interval of patients. Objective: This is a systematic review and metanalysis designed to assess the effect of hydroxychloroquine with or without the addition of azithromycin on the QTc of hospitalized patients with COVID-19. Materials and methods: PubMed, Scopus, Cochrane and MedRxiv databases were reviewed. A random effect model meta-analysis was used, and I-square was used to assess the heterogeneity. The prespecified endpoints were ΔQTc, QTc prolongation > 500 ms and ΔQTc > 60 ms. Results: A total of 18 studies and 7179 patients met the inclusion criteria and were included in this systematic review and meta-analysis. The use of hydroxychloroquine with or without the addition of azithromycin was associated with increased QTc when used as part of the management of patients with SARS-CoV-2 infection. The combination therapy with hydroxychloroquine plus azithromycin was also associated with statistically significant increases in QTc. Moreover, the use of hydroxychloroquine alone, azithromycin alone, or the combination of the two was associated with increased numbers of patients that developed QTc prolongation > 500 ms. Conclusion: This systematic review and metanalysis revealed that the use of hydroxychloroquine alone or in conjunction with azithromycin was linked to an increase in the QTc interval of hospitalized patients with SARS-CoV-2 infection that received these agents.

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“…No ECG abnormality was observed in any of our children who received azithromycin and chloroquine treatment. 25 Our study did not specify the treatments given to each patient individually, as the treatment guidelines frequently change according to new studies in our country and all over the world. Limitation of our study: it is a singlecenter and data for the beginning of the COVID-19 pandemic.…”

Section: Resultsmentioning

confidence: 99%

Should We Perform Laboratory and Radiographic Evaluations for All Children with COVID-19?: A Single-Center Experience

Karacı¹,

Güven²,

Boğa³

et al. 2021

Journal of Child Science

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Background The diagnostic and treatment strategies for children are limited because of the small number of children with COVID-19. A large proportion of infected children are asymptomatic or have mild symptoms. We report our experience regarding clinical characteristics, laboratory, radiologic findings, and outcomes of children with COVID-19. Materials and Methods This retrospective single-center study was conducted on children with COVID-19. The data on epidemiologic characteristics, clinical features, laboratory, and radiologic findings of patients were extracted from the hospital information management system records, and patients' forms filled upon admission. Results The median age of children was 121 months, 46.8% of the patients were females and 53.2% were males. Of the 581 children assessed, a total of 222 (38.2%) had positive test results; 69 of them (31.1%) were asymptomatic. The median absolute lymphocyte and eosinophil counts were statistically significantly lower in symptomatic children (p = 0.001; p = 0.02). Neutrophil lymphocyte ratio was statistically significantly higher in the symptomatic children (p = 0.001). Of 72 computed tomography scans, 35 (48.6%) were normal, and only 29 (40%) were consistent with classic/probable/indeterminate COVID-19 predominant pattern. Conclusion Our results showed a few laboratory abnormalities in asymptomatic polymerase chain reaction positive children; therefore, unnecessary investigation might be avoided and clinicians should consider clinical symptoms.

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QT interval evaluation associated with the use of hydroxychloroquine with combined use of azithromycin among hospitalised children positive for coronavirus disease 2019

Cited by 11 publications

References 13 publications

Cardiovascular impact of COVID-19 with a focus on children: A systematic review

Cardiovascular impact of COVID-19 with a focus on children: A systematic review

Effect of Hydroxychloroquine on QTc in Patients Diagnosed with COVID-19: A Systematic Review and Meta-Analysis

Should We Perform Laboratory and Radiographic Evaluations for All Children with COVID-19?: A Single-Center Experience

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