Torsades de pointes induced by antibiotics

BackgroundSeveral frequently used antibiotics are associated with an arrhythmia called “torsades de pointes” (TdP). This potentially fatal arrhythmia is considered unpredictable.MethodsIn order to investigate the prevalence of risk factors for TdP prior to initiation of antibiotic therapy, we conducted a literature search for all published reports on TdP induced by antibiotics and we asked pharmaceutical companies for additional unpublished reports.ResultsWe studied 61 reports on 78 patients with TdP induced by antibiotics. Female gender was the most common risk factor for TdP: 66.7% (n = 52) of all patients were women. Advanced heart disease and concomitant use of a QT interval-prolonging agent or an inhibitor of liver drug metabolism were also frequently present (59% and 48.7%, respectively). Most patients had at least one and 58 patients (74.3%) had two risk factors or more for TdP prior to initiation of antibiotic therapy.ConclusionContrary to common belief, TdP induced by antibiotics may be predictable by simple history-taking and by obtaining a baseline electrocardiogram. We wish to draw attention to risk factors for TdP prior to the initiation of antibiotic therapy.