Risks of Cardiac Arrhythmia and Mortality Among Patients Using New-Generation Macrolides, Fluoroquinolones, and β-Lactam/β-Lactamase Inhibitors: A Taiwanese Nationwide Study

Chou, Hsiu‐Chuan; Wang, Jiun‐Ling; Chang, Chia‐Hsuin; Lai, Chao‐Lun; Lai, Mei-Shu; Chan, Kathryn

doi:10.1093/cid/ciu914

Cited by 77 publications

(100 citation statements)

References 29 publications

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“…Similarly, no significant differences in cardiovascular mortality were found in 205,205 ciprofloxacin users compared with amoxicillin-clavulanic acid users (11). On the contrary, the QT prolonging antimicrobial agent's azithromycin and moxifloxacin were associated with an increased risk of cardiovascular mortality (10,11). In the third study, 1,830,000 prescriptions for ciprofloxacin were compared with prescriptions for penicillin V, and the risk of arrhythmia was not statistically significant increased (12).…”

Section: Qtc Interval (Ms); Fridericia's Formulamentioning

confidence: 91%

“…In a population based cohort study with 265,000 ciprofloxacin prescriptions, no differences in cardiovascular mortality or all-cause mortality were seen during a 10-days course of ciprofloxacin compared with amoxicillin, an antimicrobial agent that is not associated with QT prolongation (10). Similarly, no significant differences in cardiovascular mortality were found in 205,205 ciprofloxacin users compared with amoxicillin-clavulanic acid users (11). On the contrary, the QT prolonging antimicrobial agent's azithromycin and moxifloxacin were associated with an increased risk of cardiovascular mortality (10,11).…”

Section: Qtc Interval (Ms); Fridericia's Formulamentioning

confidence: 94%

“…Ciprofloxacin seems to be the fluoroquinolone with the lowest risk of QT prolongation and it is questionable whether ciprofloxacin has a clinically relevant QT prolonging effect (4,5). Ciprofloxacin has been associated with TdP in various case reports (5,6), but other studies suggested that there is no increased risk of QT prolongation or TdP (7)(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

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Ciprofloxacin does not Prolong the QTc Interval: A Clinical Study in ICU Patients and Review of the Literature

Heemskerk

Woldman²,

Pereboom

et al. 2017

J Pharm Pharm Sci

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Summary -Purpose. Ciprofloxacin may prolong the QT interval and increase the risk of Torsade de Pointes (TdP). Intravenous administration of ciprofloxacin in patients with additional risks may elevate the risk of QTc interval prolongation. We prospectively assessed whether intravenous ciprofloxacin prolongs the QT interval in patients with additional co-morbidities and risk factors. We also reviewed the literature on the QT prolonging effect or TdP inducing effect of ciprofloxacin. Methods. ICU Patients who were treated with intravenous ciprofloxacin as part of their therapy were recruited. ECG was recorded within 60 min before start and in the last 30 min of 1 h infusion, or within 30 min after the end of ciprofloxacin infusion. QT interval was corrected for the heart rate using both Bazett's and Fridericia's formula. The changes were analyzed using the paired Student's t-test. Results. Ten patients were included in the study (average age 74-y, 6 males). The average baseline QTc interval corrected with Bazett's formula was 448 ms that was shortened during or after ciprofloxacin infusion by 3 ms and 2 ms based on Bazett's (p=0.67) and Fridericia's (p=0.68) formula, respectively. No observational study or cohort study thus far has shown that ciprofloxacin has a QT prolonging effect or increases the risk of TdP or (cardiovascular) mortality. Conclusion. Based on our results and the results of previous studies, it is unlikely that ciprofloxacin has a clinically relevant QT prolonging effect or an increased risk of TdP.

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Section: Qtc Interval (Ms); Fridericia's Formulamentioning

confidence: 91%

Section: Qtc Interval (Ms); Fridericia's Formulamentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

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Ciprofloxacin does not Prolong the QTc Interval: A Clinical Study in ICU Patients and Review of the Literature

Heemskerk

Woldman²,

Pereboom

et al. 2017

J Pharm Pharm Sci

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“…To date, only 1 observational study has investigated the association between azithromycin use and ventricular arrhythmia specifically. 22 Given the conflicting findings regarding this widely used antibiotic and the lack of data on ventricular arrhythmia specifically, we aimed to quantify the association between azithromycin use and the risk of ventricular arrhythmia using data from a network of 7 health care databases from 5 European countries.…”

mentioning

confidence: 99%

Use of azithromycin and risk of ventricular arrhythmia

Trifirò

Ridder

Sultana

et al. 2017

CMAJ

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A zithromycin is a widely prescribed broad-spectrum macrolide used mainly for the treatment of respiratory and urinary tract bacterial infections. Concerns have been raised recently regarding its arrhythmogenic potential, a risk already known to be associated with the first marketed macrolide, erythromycin.1-6 Several case reports have described QTinterval prolongation, 7-9 torsades de pointes 10-12 and polymorphic ventricular tachycardia 13 following use of azithromycin. Many observational studies have reported conflicting results about the association between azithromycin use and cardiovascular death.14-21 Because the known azithromycin-related cardiac events are related to QT-interval prolongation, torsades de pointes and ventricular arrhythmia, 18,19 these observational studies are limited by the broad category of cardiovascular death used as an outcome, which likely only partially captured cardiac risk associated with azithromycin use. To date, only 1 observational study has investigated the association between azithromycin use and ventricular arrhythmia specifically. 22Given the conflicting findings regarding this widely used antibiotic and the lack of data on ventricular arrhythmia specifically, we aimed to quantify the association between azithromycin use and the risk of ventricular arrhythmia using data from a network of 7 health care databases from 5 European countries. Methods Study design and settingWe conducted a nested case-control study within a cohort of new antibiotic users identified from a network of 7 populationbased health care databases in 5 European countries that partic- ABSTRACT BACKGROUND: There are conflicting findings from observational studies of the arrhythrogenic potential of azithromycin. Our aim was to quantify the association between azithromycin use and the risk of ventricular arrhythmia. RESEARCH Use of azithromycin and risk of ventricular arrhythmia

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“…Judicious use of procalcitonin to assess CAP severity and to shorten duration of antibiotic therapy, is probably best way forwards in limiting multidrug resistant pathogens [42][43][44][45][46][47][48].…”

Section: Antimicrobial Therapymentioning

confidence: 99%

Macrolides: Are They Safe Bet in Management of Community Acquired Pneumonia (CAP) in Elderly Patients Admitted to an Intensive Care Unit (ICU)

Inzirillo¹,

Giorgetta²,

Ravalli³

et al. 2017

Insights Chest Dis

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Risks of Cardiac Arrhythmia and Mortality Among Patients Using New-Generation Macrolides, Fluoroquinolones, and β-Lactam/β-Lactamase Inhibitors: A Taiwanese Nationwide Study

Cited by 77 publications

References 29 publications

Ciprofloxacin does not Prolong the QTc Interval: A Clinical Study in ICU Patients and Review of the Literature

Ciprofloxacin does not Prolong the QTc Interval: A Clinical Study in ICU Patients and Review of the Literature

Use of azithromycin and risk of ventricular arrhythmia

Macrolides: Are They Safe Bet in Management of Community Acquired Pneumonia (CAP) in Elderly Patients Admitted to an Intensive Care Unit (ICU)

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