Analysis of QTc Interval during Levofloxacin Prescription in Cardiac Patients with Pneumonia

Author(s): Lida Shojaei, Mohammad Ruzbahani, Shiva Khajavian, Soodeh Shahsavari, Negin Tamasoki, Mina Rajabian, Farzaneh Moradi, Foroud Shahbazi*

Journal Name: Current Drug Safety

Volume 15 , Issue 2 , 2020

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Graphical Abstract:


Background: Medications induced QT prolongation could cause ventricular arrhythmia, torsade de pointes, and death.

Objective: The purpose of this study was to evaluate the magnitude of QTc interval prolongation as a result of levofloxacin treatment in patients admitted to cardiology wards.

Methods: This was a cross-sectional study conducted in the coronary care units and general wards of the Imam Ali Heart Hospital in Kermanshah, Iran. The QTc interval was determined at baseline and after 72 hours of levofloxacin administration. Changes in the QTc interval before and after the levofloxacin prescription were determined.

Results: The mean age of recruited patients was 63.26 ± 14.56 years. More than 80% of patients who received levofloxacin experienced QTc prolongation. The QTc interval was increased significantly after levofloxacin administration (15.68 ± 26.84 milliseconds) (p<0.001). These changes remained significant after excluding medications with QTc lengthening properties (p<0.001).

Conclusion: Treatment with levofloxacin in patients with heart disease increases the risk of QT prolongation.

Keywords: Arrhythmias, cardiovascular drugs, drug safety, fluoroquinolones, pneumonia, QT prolongation.

Roth GA, Johnson C, Abajobir A, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol 2017; 70(1): 1-25.
[] [PMID: 28527533]
Abolbashari M, Macaulay TE, Whayne TF, Mukherjee D, Saha S. Polypharmacy in cardiovascular medicine: Problems and promises! Cardiovasc Hematol Agents Med Chem 2017; 15(1): 31-9.
[] [PMID: 28552061]
Pedrós C, Quintana B, Rebolledo M, Porta N, Vallano A, Arnau JM. Prevalence, risk factors and main features of adverse drug reactions leading to hospital admission. Eur J Clin Pharmacol 2014; 70(3): 361-7.
[] [PMID: 24362489]
Tisdale JE. Drug-induced QT interval prolongation and torsades de pointes: Role of the pharmacist in risk assessment, prevention and management. Can Pharm J 2016; 149(3): 139-52.
[] [PMID: 27212965]
Drug and Therapeutics Bulletin. QT interval and drug therapy. BMJ 2016; 353: i2732.
[PMID: 27334640]
Porta-Sánchez A, Gilbert C, Spears D, et al. Incidence, diagnosis, and management of qt prolongation induced by cancer therapies: A systematic review. J Am Heart Assoc 2017; 6(12)e007724
[] [PMID: 29217664]
Li M, Ramos LG. Drug-induced QT prolongation and torsades de pointes. PT 2017; 42(7): 473-7.
[PMID: 28674475]
Wiśniowska B, Tylutki Z, Wyszogrodzka G, Polak S. Drug-drug interactions and QT prolongation as a commonly assessed cardiac effect - comprehensive overview of clinical trials. BMC Pharmacol Toxicol 2016; 17: 12.
[] [PMID: 26960809]
DeLaney MC. Risks associated with the use of fluoroquinolones. Br J Hosp Med (Lond) 2018; 79(10): 552-5.
[] [PMID: 30290736]
Kabbani S, Hersh AL, Shapiro DJ, Fleming-Dutra KE, Pavia AT, Hicks LA. Opportunities to improve fluoroquinolone prescribing in the United States for adult ambulatory care visits. Clin Infect Dis 2018; 67(1): 134-6.
[] [PMID: 29373664]
Owens RC Jr. Risk assessment for antimicrobial agent-induced QTc interval prolongation and torsades de pointes. Pharmacotherapy 2001; 21(3): 301-19.
[] [PMID: 11253855]
Heemskerk C, Woldman E, Pereboom M, et al. Ciprofloxacin does not prolong the QTc interval: A clinical study in ICU patients and review of the literature. J Pharm Pharm Sci 2017; 20(1): 360-4.
[] [PMID: 29145929]
Nykamp DL, Blackmon CL, Schmidt PE, Roberson AG. QTc prolongation associated with combination therapy of levofloxacin, imipramine, and fluoxetine. Ann Pharmacother 2005; 39(3): 543-6.
[] [PMID: 15687478]
Knorr JP, Moshfeghi M, Sokoloski MC. Ciprofloxacin-induced Q-T interval prolongation. Am J Health Syst Pharm 2008; 65(6): 547-51.
Zeuli JD, Wilson JW, Estes LL. Effect of combined fluoroquinolone and azole use on QT prolongation in hematology patients. Antimicrob Agents Chemother 2013; 57(3): 1121-7.
[] [PMID: 23229485]
Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44(Suppl. 2): S27-72.
[] [PMID: 17278083]
Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 2019; 200(7): e45-67.
[] [PMID: 31573350]
Williams GC, Dunnington KM, Hu MY, et al. The impact of posture on cardiac repolarization: More than heart rate? J Cardiovasc Electrophysiol 2006; 17(4): 352-8.
[] [PMID: 16643354]
Kervezee L, Gotta V, Stevens J, et al. Levofloxacin‐induced QTc prolongation depends on the time of drug administration. CPT Pharmacometrics Syst Pharmacol 2016; 5(9): 466-74.
[] [PMID: 27479699]
Tsikouris JP, Peeters MJ, Cox CD, Meyerrose GE, Seifert CF. Effects of three fluoroquinolones on QT analysis after standard treatment courses. Ann Noninvasive Electrocardiol 2006; 11(1): 52-6.
Wooten JM. Drug-induced QT prolongation. South Med J 2006; 99(1): 16.
[] [PMID: 16466115]
Gandhi PJ, Menezes PA, Vu HT, Rivera AL, Ramaswamy K. Fluconazole- and levofloxacin-induced torsades de pointes in an intensive care unit patient. Am J Health Syst Pharm 2003; 60(23): 2479-83.
[] [PMID: 14686224]
Makaryus AN, Byrns K, Makaryus MN, Natarajan U, Singer C, Goldner B. Effect of ciprofloxacin and levofloxacin on the QT interval: is this a significant “clinical” event? South Med J 2006; 99(1): 52-6.
[] [PMID: 16466123]
Liu X, Ma J, Huang L, et al. Fluoroquinolones increase the risk of serious arrhythmias: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96(44)e8273
[] [PMID: 29095256]
Rao GA, Mann JR, Shoaibi A, et al. Azithromycin and levofloxacin use and increased risk of cardiac arrhythmia and death. Ann Fam Med 2014; 12(2): 121-7.
[] [PMID: 24615307]
Lapi F, Wilchesky M, Kezouh A, Benisty JI, Ernst P, Suissa S. Fluoroquinolones and the risk of serious arrhythmia: A population-based study. Clin Infect Dis 2012; 55(11): 1457-65.
[] [PMID: 22865870]
Cho Y, Park HS. Association of oral ciprofloxacin, levofloxacin, ofloxacin and moxifloxacin with the risk of serious ventricular arrhythmia: A nationwide cohort study in Korea. BMJ Open 2018; 8(9)e020974
[] [PMID: 30269062]
Al-Khatib SM, LaPointe NM, Kramer JM, Califf RM. What clinicians should know about the QT interval. JAMA 2003; 289(16): 2120-7.
[] [PMID: 12709470]
Brunetti L, Lee S-M, Nahass RG, et al. The risk of cardiac events in patients who received concomitant levofloxacin and amiodarone. Int J Infect Dis 2019; 78: 50-6.
[] [PMID: 30385404]
Hafermann MJ, Namdar R, Seibold GE, Page RL II. Effect of intravenous ondansetron on QT interval prolongation in patients with cardiovascular disease and additional risk factors for torsades: A prospective, observational study. Drug Healthc Patient Saf 2011; 3: 53-8.
[PMID: 22046106]
Haverkamp W, Breithardt G, Camm AJ, et al. The potential for QT prolongation and pro-arrhythmia by non-anti-arrhythmic drugs: clinical and regulatory implications. Report on a Policy Conference of the European Society of Cardiology. Cardiovasc Res 2000; 47(2): 219-33.
[] [PMID: 10947683]

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Article Details

Year: 2020
Published on: 19 June, 2020
Page: [111 - 116]
Pages: 6
DOI: 10.2174/1574886315666200213112702
Price: $65

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