Life‐Threatening Bradyarrhythmia After Massive Azithromycin Overdose

  title={Life‐Threatening Bradyarrhythmia After Massive Azithromycin Overdose},
  author={John Arthur Tilelli and Kathleen M. Smith and Robert Pettignano},
  journal={Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy},
A 9‐month‐old infant was inadvertently administered azithromycin 50 mg/kg, taken from floor stock, instead of the prescribed ceftriaxone. Shortly thereafter, she became unresponsive and pulseless. The initial heart rhythm observed when cardiopulmonary resuscitation was started was a wide‐complex bradycardia, with a prolonged rate‐corrected QT interval and complete heart block. The baby was resuscitated with epinephrine and atropine, but she suffered severe anoxic encephalopathy. Torsade de… 

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Chronic exposure to azithromycin increases cardiac Na+ current to promote intracellular Na+ loading, providing a potential mechanistic basis for the novel form of proarrhythmia seen with this macrolide antibiotic.

Azithromycin Can Prolong QT Interval and Suppress Ventricular Contraction, but Will Not Induce Torsade de Pointes

Azithromycin can be considered to lack proarrhythmic potential, but caution has to be paid on its use for patients with left ventricular dysfunction, as it is reported to increase the risk of death from cardiovascular causes among patients with high baseline risk.

Electrophysiologic Studies on the Risks and Potential Mechanism Underlying the Proarrhythmic Nature of Azithromycin

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The cardiotoxicity of macrolides: the role of interactions

The present review addresses the intrinsic proarrhythmogenic effect of macrolides and the role of interactions in their cardiotoxicity and suggests that erythromycin and clarithromycin have the greatest potential for causing QT interval prolongation and TdP.

Azithromycin, cardiovascular risks, QTc interval prolongation, torsade de pointes, and regulatory issues: A narrative review based on the study of case reports

A systematic review of case reports sought to determine factors that link to azithromycin-induced/associated QTc interval prolongation and torsade de pointes and found 12 cases: seven female and five male.

Modelling sudden cardiac death risks factors in patients with coronavirus disease of 2019: the hydroxychloroquine and azithromycin case

  • J. MontnachI. BaróF. CharpentierM. De WaardG. Loussouarn
  • Medicine, Biology
    Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
  • 2021
The easy-to-use O'Hara-Rudy model can be applied to assess the QT-prolongation potential of off-label drugs, beyond HCQ and AZM, in different conditions representative of COVID-19 patients and to evaluate the potential impact of additional drug used to limit the arrhythmogenic risk.

Evaluation of azithromycin induced cardiotoxicity in rats.

Although there are possible cardiovascular adverse effects associated with the azithromycin treatment according to some case reports and cohort studies, there is no experimental study evaluating

Use and safety of azithromycin in neonates: a systematic review

Azithromycin significantly reduces the risk of bronchopulmonary dysplasia (BPD) in extremely premature neonates and the relationship between azithromyzin and IHPS requires further investigation.



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Erythromycin induced Torsades de Pointes: case report and review of the literature.

We report a case of an 82 year old woman with bilateral pneumonia who developed repeated episodes of polymorphic ventricular tachycardia with QT prolongation (Torsades de Pointes) after intravenous

Is azithromycin treatment associated with prolongation of the Q-Tc interval?

In previously healthy persons, a modest statistically insignificant prolongation of the Q-Tc interval without clinical consequences was observed after completion of a course of 3 g of azithromycin administered over a period of 5 days for solitary erythema migrans.

Erythromycin-induced QT prolongation and polymorphic ventricular tachycardia (torsades de pointes): case report and review.

A case of QT prolongation and polymorphic ventricular tachycardia that was precipitated by the intravenous administration of erythromycin is reported, which is in contrast to most other previously described patients.

Comparative Pharmacodynamic Analysis of Q-T Interval Prolongation Induced by the Macrolides Clarithromycin, Roxithromycin, and Azithromycin in Rats

RxM and AZM were estimated to be less potent at provoking arrhythmia than EM and CAM, and should be useful for making a safer choice of an appropriate agent for patients with electrocardiographic risk factors.

Torsades de pointes induced by erythromycin.

We describe two patients who develop torsades de pointes in a temporal relationship to the intravenous administration of erythromycin lactobionate in the absence of other drugs or metabolic

Milrinone Facilitates Resuscitation From Cardiac Arrest and Attenuates Postresuscitation Myocardial Dysfunction

Milrinone facilitates resuscitation from prolonged VF and attenuates LV dysfunction after resuscitation without worsening major determinants of myocardial oxygen demand.

Adverse Effects of Macrolide Antibacterials

Physicians should be alerted to the possibility of unusual toxicity that could also emerge in the future from the new and recently developed macrolide antibacterials, coinciding with their expanded clinical use worldwide.

Drugs That Induce Repolarization Abnormalities Cause Bradycardia in Zebrafish

This simple high-throughput assay is a promising addition to the repertoire of preclinical tests for drug-induced repolarization abnormalities, and the genetic tractability of the zebrafish will allow the exploration of heritable modifiers of such drug effects.

Concomitant risk factors in reports of torsades de pointes associated with macrolide use: review of the United States Food and Drug Administration Adverse Event Reporting System.

Concomitant risk factors mentioned in reports of torsades de pointes, a rare ventricular arrhythmia, that occurred in association with administration of macrolide antimicrobials, including azithromycin, were examined.