What antibiotics prolong the QT interval?

Antimicrobials that are associated with QT prolongation include the macrolides/ketolides, certain fluoroquinolones and antimalarials, pentamidine, and the azole antifungals.

What antibiotics do not cause QT prolongation?

In general, clinicians should be aware that azithromycin and levofloxacin are relatively safe for patients without complications or additional risk factors of QT prolongation, and decision regarding the initiation of medication therapy should be made on a case-by-case basis.

Do cephalosporins prolong QT?

In the adverse event reports, the authors found that the combination of ceftriaxone (Rocephin), a cephalosporin antibiotic, and lansoprazole (Prevacid), a proton-pump inhibitor, prolongs the QT interval.

What antibiotics cause torsades?

Introduction: Macrolides, linezolid, imipenem-cilastatin, fluoroquinolones, penicillin combinations, and ceftriaxone are known to be associated with Torsades de pointes/QT prolongation (TdP/QTP).

Do antibiotics cause QT prolongation?

For more than a decade, numerous studies have reported that macrolide and fluoroquinolone antibiotics have been associated with QT-interval prolongation, torsades de pointes and an increased incidence of sudden death.

How does QT prolongation cause torsades?

In the long QT syndromes (LQTS), malfunction of ion channels impairs ventricular repolarisation and triggers a characteristic ventricular tachyarrhythmia: torsade de pointes. Symptoms in the LQTS (syncope or cardiac arrest) are caused by this arrhythmia.

Do antimicrobials prolong the QT interval?

Antimicrobials and QT prolongation. It is noteworthy that fluoroquinolones, a common alternative to the macrolides, also prolong the QT interval. The mechanisms responsible for QT prolongation by antimicrobials are numerous (Table 2 ), though block of IKr at its intracellular vestibule is by far the most common cause.

Do antibiotics prolong QT with EKG monitoring?

If an antibiotic known to prolong QT must be given in an individual case (no safer options exist), EKG monitoring may be used to mitigate risk, similar to a risk management plan we use in our institution to guide the administration of droperidol, a drug that carries a “black box” warning in the US for QT prolongation and torsades de pointes (9).

Which antibiotics should be avoided in patients with congenital long QT syndrome?

Telithromycin should also be avoided in patients with congenital long QT syndrome. Practical Considerations for the Prescriber: Clinicians need to be aware that some antibiotics may produce clinically significant arrhythmias, and that risk is not uniform across classes or within a class.

Does moxifloxacin prolong the Qt?

Moxifloxacin has had special attention paid to QT prolongation both pre-approval (in vitro studies suggested an effect on cardiac ventricular repolarization) and post approval.