The FDA released a warning today that azithromycin may exacerbate existing QT prolongation leading to fatal arrhythmias. Per today’s statement: “Health care professionals should consider the risk of torsades de pointes and fatal arrhythmia when considering treatment options with azithromycin or alternative antibacterial drugs.”
(More after the jump)
“Groups at higher risk include:
- Patients with known prolongation of the QT interval, a history of torsades de pointes, congenital long QT syndrome, bradyarrhythmias, or uncompensated heart failure
- Patients on drugs known to prolong the QT interval
- Patients with ongoing proarrhythmic conditions such as uncorrected hypokalemia or hypomagnesemia, clinically significant bradycardia, and in patients receiving Class IA (quinidine, procainamide) or Class III (dofetilide, amiodarone, sotalol) antiarrhythmic agents.
Elderly patients and patients with cardiac disease may be more susceptible to the effects of arrhythmogenic drugs on the QT interval.”
Read the full statement here; more news coverage of the warning here.
3 replies on “Azithromycin and Arrhythmias”
Jen-
Do you anticipate the CDC revising recommendations based on this warning?
I wonder if this warning is for our one-dose prophylaxis or a course of use for a week or whatever a regular presecription would require?
I don’t know that CDC will revise guidelines (I tend to think no), and the warning issued doesn’t speak to dose-related risk. I think it’s an important piece of information to consider for some patients, and gets folded into the available evidence as we consider best course of treatment for each patient. But it does (re)emphasize the importance of looking at treatment issues on a case by case basis rather than just rotely give meds to everyone who comes in post-assault simply because we have standing orders. And it should become part of the counseling for patients so that they can make an informed decision about STI prophylaxis.