Abstract
Objective
To determine the incidence of ventricular tachycardia and ventricular fibrillation
in patients with prolonged corrected QT interval (QTc) who received levofloxacin through
retrospective chart review at a tertiary care teaching hospital in the United States.
Patients and Methods
We selected 1004 consecutive hospitalized patients with prolonged QTc (>450 ms) between
October 9, 2009 and June 12, 2012 at our institution. Levofloxacin was administered
orally and/or intravenously and adjusted to renal function in the inpatient setting.
The primary outcome measure was sustained ventricular tachycardia recorded electrocardiographically.
Results
With a median time from the start of levofloxacin use to hospital discharge (or death)
of 4 days (range, 1-94 days), only 2 patients (0.2%; 95% CI, 0.0%-0.7%) experienced
the primary outcome of sustained ventricular tachycardia after the initiation of levofloxacin
use.
Conclusion
In this study, the short-term risk for sustained ventricular tachycardia in patients
with a prolonged QTc who subsequently received levofloxacin was very rare. These results
suggest that levofloxacin may be a safe option in patients with prolonged QTc; however,
studies with longer follow-up are needed.
Abbreviations and Acronyms:
ECG (electrocardiogram), HERG (human-a-go-go-ether-related gene), QTc (corrected QT interval)To read this article in full you will need to make a payment
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References
- Fluoroquinolones and the risk of serious arrhythmia: a population-based study.Clin Infect Dis. 2012; 55: 1457-1465
- QT prolongation and torsade de pointes induced by fluoroquinolones: infrequent side effects from commonly used medications.Cardiology. 2011; 120: 103-110
- QTC interval prolongation and polymorphic ventricular tachycardia in association with levofloxacin.Am J Med. 1999; 107: 528-529
- QTc prolongation associated with combination therapy of levofloxacin, imipramine, and fluoxetine.Ann Pharmacother. 2005; 39: 543-546
- Institution-wide QT alert system identifies patients with a high risk of mortality.Mayo Clin Proc. 2013; 88: 315-325
- Cardiovascular risks with azithromycin and other antibacterial drugs.N Engl J Med. 2013; 368: 1665-1668
- Clinical relevance and management of drug-related QT interval prolongation.Pharmacotherapy. 2003; 23: 881-908
US Food and Drug Administration. Levofloxacin: Highlights of Prescribing Information. 2008. http://www.fda.gov/downloads/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/UCM133684.pdf. Accessed March 16, 2015.
- Torsades de pointes associated with fluoroquinolones: importance of concomitant risk factors.Clin Pharmacol Ther. 2004; 75: 242-247
- Levofloxacin induced polymorphic ventricular tachycardia with normal QT interval.Pacing Clin Electrophysiol. 2001; 24: 895-897
- Effects of fluoroquinolones on HERG currents.Eur J Pharmacol. 2000; 406: 341-343
- Effects of fluoroquinolones on HERG channels and on pancreatic beta-cell ATP-sensitive K+ channels.Toxicology. 2006; 228: 239-248
- Anti-HERG activity and the risk of drug-induced arrhythmias and sudden death.Eur Heart J. 2005; 26: 590-597
- Current concepts in the mechanisms and management of drug-induced QT prolongation and torsade de pointes.Am Heart J. 2007; 153: 891-899
- Measuring the effects of supratherapeutic doses of levofloxacin on healthy volunteers using four methods of QT correction and periodic and continuous ECG recordings.J Clin Pharmacol. 2004; 44: 464-473
- Antibiotic-induced cardiac arrhythmias.Cardiovasc Ther. 2014; 32: 19-25
- Effects of sparfloxacin, grepafloxacin, moxifloxacin, and ciprofloxacin on cardiac action potential duration.Eur J Pharmacol. 2000; 406: 449-452
- HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes: document endorsed by HRS, EHRA, and APHRS in May 2013 and by ACCF, AHA, PACES, and AEPC in June 2013.Heart Rhythm. 2013; 10: 1932-1963
- QT interval prolongation in end-stage liver disease cannot be explained by nonhepatic factors.Ann Noninvasive Electrocardiol. 2014; 19: 574-581
- Gatifloxacin-induced QTc prolongation and ventricular tachycardia.Pharmacotherapy. 2001; 21: 361-362
- Risk assessment for antimicrobial agent-induced QTc interval prolongation and torsades de pointes.Pharmacotherapy. 2001; 21: 301-319
CredibleMeds. Resources for healthcare professionals. https://www.crediblemeds.org/everyone/composite-list-all-qtdrugs/. Accessed June 18, 2014.
- Prescription of QT-prolonging drugs in a cohort of about 5 million outpatients.Am J Med. 2003; 114: 135-141
- Pharmacoepidemiology of QT-interval prolonging drug administration in critically ill patients.Pharmacoepidemiol Drug Saf. 2008; 17: 971-981
- Frequency of high-risk use of QT-prolonging medications.Pharmacoepidemiol Drug Saf. 2006; 15: 361-368
- QRS widening and QT prolongation under bupropion: a unique cardiac electrophysiological profile.Fundam Clin Pharmacol. 2012; 26: 599-608
- QT interval prolongation associated with venlafaxine administration.Int J Cardiol. 2006; 109: 116-117
- QT alterations in psychopharmacology: proven candidates and suspects.Curr Drug Saf. 2010; 5: 97-104
Article Info
Publication History
Published online: April 08, 2015
Identification
Copyright
© 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
