Benn Kerri, Salman Sam, Page-Sharp Madhu, Davis Timothy M E, Buttery Jim P
Department of Infection and Immunity, Monash Children's Hospital, Clayton, Victoria, Australia.
School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.
Am J Case Rep. 2017 Aug 11;18:883-886. doi: 10.12659/ajcr.905400.
BACKGROUND Azithromycin is a macrolide antibiotic widely used to treat respiratory, urogenital, and other infections. Gastrointestinal upset, headache, and dizziness are common adverse effects, and prolongation of the rate-corrected electrocardiographic QT interval and malignant arrhythmias have been reported. There are rare reports of bradycardia and hypothermia but not in the same patient. CASE REPORT A 4-year-old boy given intravenous azithromycin as part of treatment for febrile neutropenia complicating leukemia chemotherapy developed hypothermia (rectal temperature 35.2°C) and bradycardia (65 beats/minute) after the second dose, which resolved over several days post-treatment, consistent with persistence of high tissue azithromycin concentrations relative to those in plasma. A sigmoid Emax pharmacokinetic/pharmacodynamic model suggested a maximal azithromycin-associated reduction in heart rate of 23 beats/minute. Monitoring for these potential adverse effects should facilitate appropriate supportive care in similar cases. CONCLUSIONS Recommended azithromycin doses can cause at least moderate bradycardia and hypothermia in vulnerable pediatric patients, adverse effects that should prompt appropriate monitoring and which may take many days to resolve.
阿奇霉素是一种广泛用于治疗呼吸道、泌尿生殖系统及其他感染的大环内酯类抗生素。胃肠道不适、头痛和头晕是常见的不良反应，且已有报道称其会导致校正心率后的心电图QT间期延长及恶性心律失常。有关于心动过缓和体温过低的罕见报道，但未出现在同一患者身上。病例报告：一名4岁男孩因白血病化疗并发发热性中性粒细胞减少症接受静脉注射阿奇霉素治疗，在第二次给药后出现体温过低（直肠温度35.2°C）和心动过缓（65次/分钟），治疗后数天症状缓解，这与组织中阿奇霉素浓度相对于血浆中浓度持续处于高位一致。一个S形Emax药代动力学/药效学模型表明，阿奇霉素相关的心率最大降低值为23次/分钟。对这些潜在不良反应进行监测应有助于在类似病例中进行适当的支持性护理。结论：推荐的阿奇霉素剂量可在易受影响的儿科患者中导致至少中度的心动过缓和体温过低，这些不良反应应促使进行适当监测，且可能需要数天才能缓解。
