Cornett Elyse, Novitch Matthew B, Kaye Alan D, Pann Chris A, Bangalore Harish Siddaiah, Allred Gregory, Bral Matthew, Jhita Preya K, Kaye Adam M
a Departments of Anesthesiology and Pharmacology , Toxicology & Neuroscience, LSU Health Shreveport , Shreveport , LA , USA.
b Medical College of Wisconsin , Wausau , WI , USA.
Postgrad Med. 2017 Sep;129(7):715-724. doi: 10.1080/00325481.2017.1362938. Epub 2017 Aug 10.
While there is evidence for cardiac arrhythmias associated with macrolide and fluoroquinolone antibiotics, there is still debate among health care providers as to whether this risk of arrhythmia is overstated. A joint panel of the US Food and Drug Administration suggested that macrolide and fluoroquinolone labels need much stronger warnings regarding the possible serious adverse cardiac effects associated with these antibiotics, especially since they are so widely prescribed. And while health care providers may differ on the pertinence of the cardiac risks associated with antibiotic use, they can undoubtedly minimize the cardiac effects that are associated with these antibiotics by paying attention to the cardiac risk factors and drug history associated with the patient. Relevant studies for our review were identified from a PubMed search using keywords and combined word searches involving macrolides, fluoroquinolones, and cardiac arrhythmias. We attempted to include as many recent (>2015) articles as possible. We included case reports, randomized, controlled trials, observational studies, case-control studies, systematic reviews, and retrospective studies. Underlying cardiac issues can predispose patients to harmful cardiac side effects that can be exacerbated in the presence of antibiotics. The health care provider should rule out any risk factor associated with antibiotic-induced cardiac arrhythmia in the event that a patient does need a macrolide or fluoroquinolone antibiotic. Rigorous patient evaluation and a detailed patient history, including short and long term medication use, is the likely key to reducing any risk of cardiac arrhythmias associated with macrolides and fluoroquinolones. Clinicians should be cautious when prescribing macrolide and fluoroquinolone medications to patients with risk factors that may lead to antibiotic-induced cardiac arrhythmias, including a slow heart rate and those that are taking medications to treat arrhythmias.
虽然有证据表明大环内酯类和氟喹诺酮类抗生素与心律失常有关，但医疗保健人员对于这种心律失常风险是否被夸大仍存在争议。美国食品药品监督管理局的一个联合小组建议，大环内酯类和氟喹诺酮类药物的标签需要就这些抗生素可能产生的严重不良心脏影响给出更强有力的警告，尤其是考虑到它们的处方如此广泛。尽管医疗保健人员对于抗生素使用相关心脏风险的相关性可能存在分歧，但他们无疑可以通过关注患者的心脏风险因素和用药史来尽量减少与这些抗生素相关的心脏影响。我们通过在PubMed上使用关键词以及涉及大环内酯类、氟喹诺酮类和心律失常的组合词搜索来确定本次综述的相关研究。我们试图纳入尽可能多的近期（>2015年）文章。我们纳入了病例报告、随机对照试验、观察性研究、病例对照研究、系统评价和回顾性研究。潜在的心脏问题可能使患者易患有害的心脏副作用，而在使用抗生素时这种副作用可能会加剧。如果患者确实需要使用大环内酯类或氟喹诺酮类抗生素，医疗保健人员应排除任何与抗生素诱发心律失常相关的风险因素。严格的患者评估和详细的患者病史，包括短期和长期用药情况，可能是降低与大环内酯类和氟喹诺酮类相关心律失常风险的关键。临床医生在为有可能导致抗生素诱发心律失常风险因素的患者（包括心率缓慢的患者以及正在服用治疗心律失常药物的患者）开具大环内酯类和氟喹诺酮类药物时应谨慎。
