Short-term azithromycin use is associated with QTc interval prolongation in children with cystic fibrosis

Asım Enhoş; Hazar Doğuş Kus; Can Yilmaz Yozgat; Erkan Cakır; Hakan Yazan; Ahmet Berk Erol; Ufuk Erenberk; Yilmaz Yozgat

doi:10.1016/j.arcped.2024.02.004

Short-term azithromycin use is associated with QTc interval prolongation in children with cystic fibrosis

Arch Pediatr. 2024 Apr 17:S0929-693X(24)00060-5. doi: 10.1016/j.arcped.2024.02.004. Online ahead of print.

Authors

Asım Enhoş¹, Hazar Doğuş Kus², Can Yilmaz Yozgat³, Erkan Cakır⁴, Hakan Yazan⁵, Ahmet Berk Erol⁶, Ufuk Erenberk², Yilmaz Yozgat⁷

Affiliations

¹ Department of Cardiology, Istanbul Medipol University, Istanbul, Turkey. Electronic address: asimenhos@hotmail.com.
² Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey.
³ Faculty of Medicine, Maltepe University, Istanbul, Turkey.
⁴ Department of Pediatric Pulmonology, Istinye University Hospital, Liv Vadi Hospital, Istanbul, Turkey.
⁵ Department of Pediatric Pulmonology, Istanbul Medipol University, Istanbul, Turkey.
⁶ Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
⁷ Department of Pediatric Cardiology, Istanbul Medipol University, Istanbul, Turkey.

PMID: 38637249
DOI: 10.1016/j.arcped.2024.02.004

Abstract

Background: Azithromycin is used for children with cystic fibrosis (CF) for its immunomodulatory and anti-inflammatory action. This study investigated the short-term alterations in QTc interval associated with azithromycin prophylaxis in pediatric patients with CF.

Methods: This study included 121 patients with mild CF, of whom 76 received azithromycin (patient group) and 45 did not receive azithromycin (control group). The patient and control groups were categorized according to age as under 12 years of age and over 12 years of age. The first presentation measured all the patient and control groups at basic QTc time intervals. The QTc intervals of all patients were then remeasured systemically at 1, 3, and 6 months. Age categories and QTc intervals that were calculated at each month in the patient and control groups were compared statistically.

Results: A statistically significant difference was detected in the patient group between the initial QTc interval time and the electrocardiogram (ECG) findings in the first and third months after prophylaxis treatment (p < 0.001; p = 0.01). However, no statistically significant difference was detected in the sixth month (p > 0.05) in all groups. Almost all of the children's QTc intervals were within normal range and within the safety zone (under 0.44 s). No statistically significant difference was detected in the control group between the initial ECG and the QTc intervals measured at 1, 3, and 6 months.

Conclusion: Short-term use of azithromycin prophylaxis in pediatric patients with mild CF slightly increased the QTc interval in the first and third months of follow-up. Nevertheless, all QTc interval changes fell within the safety zone. Notably, 1 month of follow-up treatment should be performed to check for any alteration in the QTc interval. If increased QTc interval duration is not detected in the first month, azithromycin prophylaxis can be safely prescribed.

Keywords: Azithromycin prophylaxis; Childhood; Chronic lung disease; QTc prolongation.