Antimicrobials and QT prolongation
Antimicrobials and QT prolongation
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DOI：
10.1093/jac/dkw591
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发表时间：
2017-05-01
影响因子：
5.2
通讯作者：
Mason, Jay W.
中科院分区：
文献类型：
--
作者：
Mason, Jay W.
索利霉素是一种酮内酯类/大环内酯类抗生素，最近报告不具有大环内酯类预期的QT延长作用。看来它的酮取代为这一观察提供了结构基础，因为其他两种测试的酮内酯也有最小的QT效应。这是由于它们倾向于与延迟整流钾通道I-Kr结合，诱导QT延长和尖端扭转型室性心动过速的风险，它们经常干扰其他QT间期延长剂的代谢，以及它们对许多常用药物的代谢抑制的敏感性。有证据表明，医生在其处方实践中没有考虑到抗微生物剂的QT/心律失常风险。关于这个主题的教育是非常必要的。当有大环内酯类药物的适应症时，有QT风险的患者应考虑使用酮内酯类。
Solithromycin, a ketolide/macrolide antibiotic, has recently been reported to be free of the expected QT-prolonging effect of macrolides. It appears that its keto substitution provides a structural basis for this observation, as the other two tested ketolides also have minimal QT effect.Among non-cardiovascular therapies, antimicrobials probably carry the greatest potential to cause cardiac arrhythmias. This is a result of their propensity to bind to the delayed rectifier potassium channel, I-Kr, inducing QT prolongation and risk of torsades de pointes ventricular tachycardia, their frequent interference with the metabolismof other QT prolongers and their susceptibility to metabolic inhibition by numerous commonly used drugs.Unfortunately, there is evidence that medical practitioners do not take account of the QT/arrhythmia risk of antimicrobials in their prescribing practices. Education on this topic is sorely needed. When a macrolide is indicated, a ketolide should be considered in patients with a QT risk.