Antimicrobials and QT prolongation

J Antimicrob Chemother. 2017 May 1;72(5):1272-1274. doi: 10.1093/jac/dkw591.


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, IKr, inducing QT prolongation and risk of torsades de pointes ventricular tachycardia, their frequent interference with the metabolism of 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.

MeSH terms

  • Anti-Bacterial Agents / adverse effects*
  • Anti-Bacterial Agents / chemistry
  • Anti-Bacterial Agents / metabolism*
  • Anti-Bacterial Agents / therapeutic use
  • Education, Medical / methods
  • Humans
  • Ketolides / administration & dosage
  • Ketolides / therapeutic use
  • Long QT Syndrome / chemically induced*
  • Macrolides / adverse effects
  • Macrolides / chemistry
  • Macrolides / therapeutic use
  • Potassium Channels, Inwardly Rectifying / metabolism
  • Practice Patterns, Physicians'
  • Torsades de Pointes / chemically induced
  • Triazoles / adverse effects
  • Triazoles / chemistry
  • Triazoles / therapeutic use


  • Anti-Bacterial Agents
  • Ketolides
  • Macrolides
  • Potassium Channels, Inwardly Rectifying
  • Triazoles
  • solithromycin