Abstract
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 widecomplex 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 pointes and QT-interval prolongation have been reported after administration of macrolide antibiotics, including azithromycin, both intravenously and orally. This has occurred especially in the context of coadministered drugs that inhibit the cytochrome P450 (CYP) 3A4 isoenzyme, such as ketoconazole and astemizole. However, bradycardia with complete heart block has not, to our knowledge, been reported specifically with intravenous administration of azithromycin alone, either with therapeutic doses or overdose. Clinicians should be alerted about the potential of azithromycin to cause life-threatening bradycardia, and pharmacy systems should be implemented to ensure special care in the safe administration of this drug, especially when dispensed fr...Continue Reading
References
Jan 1, 1992·Intensive Care Medicine·W E HaefeliR Ritz
Mar 4, 1989·BMJ : British Medical Journal·D L MaxwellM R Hall
Aug 1, 1981·Clinical Pharmacology and Therapeutics·C A NaranjoD J Greenblatt
Jun 1, 1994·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·M W BrandrissS S Barold
Nov 1, 1993·Drug Safety : an International Journal of Medical Toxicology and Drug Experience·P PeritiA Novelli
Feb 1, 1994·Chest·B GitlerS D Buffa
Dec 1, 1995·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists
Nov 24, 1998·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Y A KaeserW E Haefeli
Apr 20, 2000·The Annals of Pharmacotherapy·M P PaiG W Amsden
Sep 19, 2000·Antimicrobial Agents and Chemotherapy·H OhtaniT Iga
Jun 28, 2002·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Douglas ShafferPeter Honig
Mar 19, 2003·Circulation·David J MilanCalum A MacRae
Nov 26, 2003·Circulation·James T NiemannRoger J Lewis
Mar 5, 2004·The New England Journal of Medicine·Dan M Roden
Sep 10, 2004·The New England Journal of Medicine·Wayne A RayC Michael Stein
Dec 16, 2004·The Annals of Pharmacotherapy·Matthew ReedGregory A Hicklin
Citations
Feb 27, 2013·Antimicrobial Agents and Chemotherapy·Rose M ViscardiKen B Waites
Dec 15, 2015·BMJ Open·Coral SmithHelen Sammons
Dec 17, 2008·British Journal of Clinical Pharmacology·Emanuel RaschiFabrizio De Ponti
Nov 5, 2014·Cardiovascular Toxicology·Hiroshi OharaAtsushi Sugiyama
Dec 4, 2016·The Journal of Pediatrics·Santiago O ValdésBrady S Moffett
Aug 29, 2014·Therapeutic Advances in Infectious Disease·Jules C HancoxAdrian Baranchuk
Jan 27, 2016·Antimicrobial Agents and Chemotherapy·Devyani DeshpandeTawanda Gumbo
Apr 15, 2017·Circulation. Arrhythmia and Electrophysiology·Zhenjiang YangKatherine T Murray
Nov 21, 2018·Xenobiotica; the Fate of Foreign Compounds in Biological Systems·Jingchen TianXingang Li
Mar 23, 2019·JMIR Medical Informatics·Chunlei TangDavid Bates
Jan 27, 2019·European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology·Rosa A M BandellCornelis Kramers
Feb 19, 2017·Cardiovascular Toxicology·Mengdan ZhangLong Chen
May 28, 2019·Pediatric Research·Raul Chavez-Valdez
Jul 19, 2020·European Journal of Clinical Pharmacology·Linan ZengLingli Zhang
May 20, 2021·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·Jérôme MontnachGildas Loussouarn