QT interval prolongation and risk of life-threatening arrhythmias during toxoplasmosis prophylaxis with spiramycin in neonates

American Heart Journal
M Stramba-BadialeP J Schwartz

Abstract

We recently reported two cases of QT interval prolongation and cardiac arrest in newborns receiving antibiotic therapy with spiramycin, a macrolide agent extensively used for toxoplasmosis prophylaxis. In this study we assessed the effects of this drug on ventricular repolarization and on the potential risk of lethal arrhythmias in eight newborn infants in whom toxoplasmosis prophylaxis after birth was necessary. Electrocardiograms (ECGs) and echocardiograms were recorded during spiramycin therapy (350,000 i.u./kg/ day) and after its withdrawal. In a control group of eight healthy newborns matched for age and sex, no differences were found between two ECGs analogously recorded. The QT interval corrected for heart rate (QTc) was longer during spiramycin therapy than after drug withdrawal (448 +/- 32 msec vs 412 +/- 10 msec, +9%, p = 0.021). QTc dispersion, expressed as the difference between the longest and the shortest value in 12 different leads (QTcmax-min), was also higher during spiramycin therapy (60 +/- 32 msec vs 34 +/- 8 msec, +76%, p = 0.021), mainly because of a major lengthening of the longest QTc (QTcmax). QTc and QTc dispersion were markedly increased in the two newborns who experienced cardiac arrest after beginni...Continue Reading

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Citations

Jun 18, 2010·Journal of Cardiovascular Pharmacology·Peter J Schwartz, Marco Stramba-Badiale
Apr 14, 2012·Journal of Cardiovascular Medicine·Bryan LebudeRobert Coben
Dec 15, 2015·BMJ Open·Coral SmithHelen Sammons
Apr 14, 2004·Chest·Carlos Van MieghemDaniel Knockaert
Feb 27, 2007·Seminars in Fetal & Neonatal Medicine·Eskild Petersen
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Jul 11, 2000·Japanese Journal of Pharmacology·J Tamargo
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May 6, 2008·Infection·J SimkóI Lorincz
Aug 2, 2003·Journal of Veterinary Internal Medicine·Melissa R FinleyLisa C Freeman
May 15, 2020·International Journal of Toxicology·Simon AuthierMichael K Pugsley

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