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. 2018 Oct 14:2018:1574806.
doi: 10.1155/2018/1574806. eCollection 2018.

Risk Evaluation of Azithromycin-Induced QT Prolongation in Real-World Practice

Young Choi  1   2 , Hong-Seok Lim  3 , Dahee Chung  1 , Jung-Gu Choi  1 , Dukyong Yoon  1   2
Affiliations

Risk Evaluation of Azithromycin-Induced QT Prolongation in Real-World Practice

Young Choi et al. Biomed Res Int. .

Abstract

Background: Azithromycin exposure has been reported to increase the risk of QT prolongation and cardiovascular death. However, findings on the association between azithromycin and cardiovascular death are controversial, and azithromycin is still used in actual practice. Additionally, quantitative assessments of risk have not been performed, including the risk of QT prolongation when patients are exposed to azithromycin in a real-world clinical setting. Therefore, in this study, we aimed to evaluate the risk of exposure to azithromycin on QT prolongation in a real-world clinical setting using a 21-year medical history database of a tertiary medical institution.

Methods: We analyzed the electrocardiogram results and relevant electronic health records of 402,607 subjects in a tertiary teaching hospital in Korea from 1996 to 2015. To evaluate the risk of QT prolongation of azithromycin, we conducted a case-control analysis using amoxicillin for comparison. Multiple logistic regression analysis was performed to correct for age, sex, accompanying drugs, and disease.

Results: The odds ratio (OR) for QT prolongation (QTc>450 ms in male and >460 ms in female) on azithromycin exposure was 1.40 (95% confidence interval [CI], 1.23-1.59), and the OR for severe QT prolongation (QTc>500 ms) was 1.43 (95% CI, 1.13-1.82). On the other hand, the ORs on exposure to amoxicillin were 1.06 (95% CI, 0.97-1.15) and 0.88 (95% CI, 0.70-1.09). In a subgroup analysis, the risk of QT prolongation in patients aged between 60 and 80 years was significantly higher when they are exposed to azithromycin.

Conclusions: The risk of QT prolongation was increased when patients, particularly the elderly aged 60-79 years, were exposed to azithromycin. Therefore, clinicians should pay exercise caution using azithromycin or consider using other antibiotics, such as amoxicillin, instead of azithromycin.

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Figures

Figure 1
Figure 1
Overview of the study process. Among the 816,421 ECG results, 402,607 ECGs which have no duplicated or repeated measurements, no outlier, and potassium (K+) and calcium (Ca+) results within one-year before ECG measurement were enrolled and divided into QT prolongation case (n=62,007) vs. control (n=340,600) or severe QT prolongation case (n=9,353) vs. control (n=393,254).
Figure 2
Figure 2
Subgroup analysis for evaluation of risk factors for QT prolongation when azithromycin is prescribed. Odds ratio was increased in elderly (60-79 years) and male patients in both QT prolongation and severe QT prolongation.
See this image and copyright information in PMC

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