Active substances: Azithromycin
Participants were recruited from 17 sites associated with 12 academic health centers in the United States.
Written informed consent was obtained from all participants. The study was approved by the institutional review board at each participating institution.
The complete protocol, including the statistical analysis plan, is available with the full text of this article at NEJM. There were no confidentiality agreements with the sponsor.
As the population ages, polypharmacy is more abundant and hospitalizations become more frequent. A study showed the prevalence of prolonged QTc to be even higher in an acute geriatric ward. Of the non-cardiac drugs, it has been proposed that macrolides are the antibiotics with the greatest QTc prolonging potential.
Macrolides are therefore more dangerous for those who simultaneously take CYP 3 A 4 inhibitors or another QTc prolonging medication metabolized by this isoenzyme. Azithromycin has been shown to have less effect on CYP 3 A 4 and is more widely used than other macrolides.
This represented 40.
During this time, azithromycin was second only to amoxicillin for treatment of sinusitis, and was mentioned 34,077,000 times. In, 40. Interestingly, the risk of sudden cardiac death observed with azithromycin occurred only within a typical 5-day course.
The rate of drug-induced TdP varies by medication class. In a population-based study of 605,127 people taking fluoroquinolone antibiotics, ventricular arrhythmias were detected in 180 patients and cardiac arrest occurred in 555 patients that had prior exposure to a quinolone.
However, this study had an extensive immeasurable time bias between drug exposure and event rate and did not take into account the incidence of sustained ventricular tachycardia in patients with known prolonged QT who subsequently received the medication.
However, in our previous work of 1,004 patients evaluating the incidence of TdP in patients with prolonged QTc who subsequently received levofloxicin.
This is in contrast to our current study noting an event rate of 0. The rate of ventricular arrhythmia in our study was far too small to speculate about potential risk factors that contribute to the development of ventricular tachycardia in patients with prolonged QTc who are given azithromycin.