Use of fluoroquinolones is a high risk factor for serious arrhythmias

Hypotheses on the relationship between the use of fluoroquinolones and the occurrence of arrhythmias were made earlier, however, the evidence was insufficient to support this fact.

According to Canadian scientists, serious arrhythmias are relatively rare. However, patients with coronary artery disease or heart failure who are at high risk of developing arrhythmias should receive these antibiotics with caution and only with absolute indications.

In light of the data on the relationship of certain fluoroquinolones with QTc prolongation and the development of torsade de pointes arrhythmias, which can lead to ventricular fibrillation, the researchers assessed the risk of life-threatening arrhythmias when taking fluoroquinolones as a class of antimicrobial agents in general or individually of them.

This study analyzed the RAMQ and MedEcho databases, which contain demographic and medical information for each of the 7 million people in Quebec.

1,838 recorded cases of life-threatening arrhythmias were identified among 605,127 patients who were prescribed fluoroquinolones, with a frequency of 4.7 cases per 10,000 person-years.

There was a tendency for an increased risk of serious arrhythmias in patients receiving fluoroquinolones compared to the control group not receiving antibiotics, but gatifloxacin was the only drug that significantly increased the risk of severe arrhythmias (risk relative 3.97).

Since the analysis was limited to patients who had not been hospitalized for 14 days before having arrhythmias, the overall risk of serious arrhythmias was significantly increased in patients taking fluoroquinolones at the time of the study, compared to patients who had received antibiotics earlier (RR 1, 76).

In non-hospitalized patients taking fluoroquinolones for the first time, this risk was particularly high: 5.8 per 10,000 person-years in general, 30 per 10,000 for gatifloxacin, 10.8 per 10,000 for moxifloxacin and 5.4 for 10,000 for ciprofloxacin.

Unlike the above drugs, the researchers note that the use of ofloxacin did not result in a high risk of serious arrhythmias.

The next step in the study of this problem is the confirmation of the results revealed in other patient populations, as well as the study of other adverse events of the cardiovascular system with the use of fluoroquinolones.