AZITHROMYCIN-INDUCED TORSADES DE POINTES

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Azithromycin (AZ) is extensively used, with millions of prescriptions written yearly. In 2013 US food and drug administration issued a warning against the pro-arrhythmogenic activity this in presence pre-existing cardiac conditions, known QT prolongation or QT-prolonging use electrolyte abnormalities.(1) A recent study collected data on over 12 million patients showing risk events AZ was rare ~0.03%, there no increased when compared to amoxicillin.(1,2) Here we report patient comorbidities who developed torsades des pointes (TdP) after 2 days initiating AZ. CASE PRESENTATION: 77-year-old African American female history acid reflux, type diabetes mellitus, hypertension, hypothyroidism, presented emergency room dyspnea dry cough for one day. On arrival, had temperature 99.5F, pulse 115 beats/min, respirations at 32 breaths/min, blood pressure 120/66 saturating 80s air, an unremarkable physical exam. She leukocytosis 12.8k, d-dimer 2.15. Computed tomography angiography ruled out pulmonary embolism but showed bibasilar opacities. normal sinus rhythm QTc 393 ECG presentation. COVID test negative; empirically treated community-acquired pneumonia IV ceftriaxone AZ, which significant clinical improvement oxygen requirement. However day hospitalization, she episode generalized tonic-clonic seizure followed by arrest secondary TdP successful resuscitation 15 minutes. Magnesium 1.9, potassium 3.8. absence factors like, disease, arrhythmias, concomitant prolonging drugs, abnormality, event attributed azithromycin. Naranjo adverse reaction scale score 6. While ICU, managed amiodarone, metoprolol, discontinued. made marked recovery extubated within 3 days, transferred floor where further arrhythmias were noted. subsequently discharged rehab short course amoxicillin-clavulanate, close cardiology follow-up. DISCUSSION: relatively safe other macrolides, reports induced solely are extremely rare. The evidence from meta-analyses systematic reviews association conflicting (3), investigations warranted assess association. CONCLUSIONS: This case serves reiterate potentially fatal commonly prescribed antibiotic. Although these rare, they should be our radar practice. REFERENCE #1: Patel H, Calip GS, DiDomenico RJ, Schumock GT, Suda KJ, Lee TA. Comparison Cardiac Events Associated With vs Amoxicillin. JAMA Network Open. 2020;3(9):e2016864-e2016864. #2: Risk azithromycin-A prediction model. PLoS One. 2020;15(10):e0240379. #3: Almalki ZS, Guo JJ. safety outcomes associated azithromycin therapy: meta-analysis randomized controlled trials. Am Health Drug Benefits. 2014;7(6):318-328. DISCLOSURES: No relevant relationships Khushdeep Chahal, source=Web Response Sangeetha Isaac, Sucheta Kundu, Ishita Mehra,