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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Tuesday, August 9, 2016

Macrolides, QTc and Dysrhythmias

Macrolide Antibiotics
R.E.B.E.L.EM - Posted by Anand Swaminathan - August 8, 2016
..."With more and more patients being prescribed macrolide antibiotics, an increasing amount of research has been put forth dealing with the safety concerns regarding these medications; specifically the thought that azithromycin use can lead to fatal ventricular arrhythmias. In addition to case reports a 2012 observational study published in the New England Journal of Medicine highlighted an association between azithromycin use and higher rate of both cardiovascular death and all-cause mortality (Ray 2012). This prompted the US Food and Drug Administration to issue warnings about the use of azithromycin and potential QT-interval prolongation and fatal ventricular dysrhythmias.
However, recent studies suggest that these concerns and warnings may not be accurate. A retrospective cohort study comparing older patients hospitalized with pneumonia that were treated with azithromycin to those who received other guideline appropriate antibiotics actually showed a lower risk of 90-day mortality in the azithromycin group. Further, there was no significant difference between the 2 groups in regards to risk of arrhythmia, heart failure or any cardiac event. (Mortensen 2014)...
Author’s Conclusions: “Among older adults prescribed macrolide antibiotics compared with nonmacrolide antibiotics, we found no difference in risk of a hospital encounter with ventricular arrhythmia within 30 days of a new prescription and a lower risk of 30-day all- cause mortality. These findings are reassuring for health care providers who prescribe macrolide antibiotics to a wide range of patients in routine care”
Our Conclusions: This study, while not without its limitations, is another piece of evidence that suggests that the risk of ventricular dysrhythmias and death secondary to macrolide antibiotic use may not be as high as once thought. The authors of this study provided a very large sample size, with clinically important outcomes.
Potential Impact to Current Practice: This study may make ED physicians more comfortable in prescribing macrolide antibiotics, although it appears that this is already the case.
Clinical Bottom Line: While this study is another step towards determining the risks of macrolide antibiotics and clinically relevant outcomes, caution should still be exercised when prescribing them to high-risk patients with poor drug clearance or with already impaired electrical activity of the heart."