Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Centre (KFSH&RC), Riyadh, Saudi Arabia.
Am J Case Rep. 2020 Nov 12;21:e926951. doi: 10.12659/AJCR.926951.
BACKGROUND Azithromycin is a commonly prescribed antibiotic due to several advantages, including the broad range of indications, spectrum of activity, favorable drug interaction profile, and convenience of dosing. Although azithromycin carries a black-box warning for QTc prolongation and ventricular arrhythmias, these are considered rare adverse effects. CASE REPORT We present the case of a 37-year-old woman who received azithromycin (500 mg) for follicular tonsillitis and was admitted for worsening of symptoms. On the same day of admission to a secondary hospital, she became unresponsive and had cardiac arrest, for which cardiopulmonary resuscitation (CPR) was performed for 26 min. As per the input from the secondary hospital, she had multiple ventricular tachycardia (VT) and ventricular fibrillation, and needed to be transferred to a tertiary care hospital for further management. Veno-arterial extracorporeal membrane oxygenation (ECMO) support was inserted to support her hemodynamics, and serial ECGs showed significant QT interval prolongation up to 600 msec. The QT prolongation resolved over 10 days and she was successfully weaned-off ECMO. CONCLUSIONS Although azithromycin has a relatively safe profile, it is also associated with life-threatening cardiac arrhythmias that may require surgical intervention to stabilize the patient hemodynamically.
阿奇霉素由于具有广泛的适应证、活性谱、良好的药物相互作用特性和方便的给药方式等优点，因此被广泛应用于临床。尽管阿奇霉素存在导致 QTc 延长和室性心律失常的黑框警告，但这些被认为是罕见的不良反应。
我们报告了一例 37 岁女性患者，因滤泡性扁桃体炎接受阿奇霉素（500mg）治疗，并因症状恶化而入院。在入住二级医院的同一天，她出现意识丧失和心脏骤停，进行了 26 分钟心肺复苏（CPR）。根据二级医院的信息，她出现了多次室性心动过速（VT）和心室颤动，需要转至三级护理医院进行进一步治疗。为了支持她的血液动力学，插入了静脉动脉体外膜肺氧合（ECMO）支持。连续心电图显示明显的 QT 间期延长，最高达 600ms。QT 延长在 10 天内得到缓解，她成功地脱离了 ECMO。
尽管阿奇霉素具有相对安全的特性，但它也与危及生命的心律失常有关，可能需要手术干预以稳定患者的血液动力学。
