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Macrolide Antibiotics and the Risk of Cardiac Arrhythmias
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Randomized, controlled trials have demonstrated that chronic therapy with macrolide antibiotics reduces the morbidity of patients with cystic fibrosis, non-cystic fibrosis bronchiectasis, chronic obstructive pulmonary disease, and nontuberculous mycobacterial infections. Lower levels of evidence indicate that chronic macrolides are also effective in treating patients with panbronchiolitis, bronchiolitis obliterans, and rejection after lung transplant. Macrolides are known to cause torsade des pointes and other ventricular arrhythmias, and a recent observational study prompted the FDA to strengthen the Warnings and Precautions section of azithromycin drug labels. This summary describes the electrophysiological effects of macrolides, reviews literature indicating that the large majority of subjects experiencing cardiac arrhythmias from macrolides have coexisting risk factors and that the incidence of arrhythmias in absence of coexisting risk factors is very low, examines recently published studies describing the relative risk of arrhythmias from macrolides, and concludes that this risk has been overestimated and suggests an approach to patient evaluation that should reduce the relative risk and the incidence of arrhythmias to the point that chronic macrolides can be used safely in the majority of subjects for whom they are recommended.
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Several approved therapeutics, especially macrolide antibiotics and antihistamines/decongestants, have been associated with syncopal episodes.
“Several approved therapeutics, especially macrolide antibiotics and antihistamines/decongestants, have been associated with syncopal episodes (708).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [708]
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Metadata
- Authors
- Albert, R. K., & Schuller, J. L.
- Affiliations
- Denver Health Medical Center (US)
- Corresponding author
- Albert, Richard K.
- ORCID
- Albert, Richard K.
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-05
- Volume
- 189
- Issue
- 10
- Pages
- 1173-1180
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- PMC
- PMC4061901
- OpenAlex
- W2134495308
- Cited by
- 163
- References
- 89
- Citations by year
- 2026: 10 · 2025: 12 · 2024: 9 · 2023: 7 · 2022: 12 · 2021: 8 · 2020: 23 · 2019: 15 · 2018: 12 · 2017: 17 · 2016: 8 · 2015: 22 · 2014: 7
- FWCI
- 2.90
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cystic Fibrosis Research Advances
- Keywords
- macrolide antibiotics, cardiac arrhythmias, torsades de pointes, ventricular arrhythmias, azithromycin, drug safety, risk factors, cystic fibrosis, non-cystic fibrosis bronchiectasis, chronic obstructive pulmonary disease, nontuberculous mycobacterial infection, lung transplant rejection, bronchiolitis obliterans, electrophysiological effects
- MeSH terms
- Anti-Bacterial Agents, Arrhythmias, Cardiac, Cystic Fibrosis, Heart Conduction System, Humans, Risk Factors, Randomized Controlled Trials as Topic, Azithromycin, Macrolides, Pulmonary Disease, Chronic Obstructive
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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