Cited by 163Cardiac electrophysiology and arrhythmiasPharmacovigilance and Adverse Drug ReactionsCystic Fibrosis Research Advances

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Macrolide Antibiotics and the Risk of Cardiac Arrhythmias

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Albert, Richard K., Schuller, Joseph L.·2014·American Journal of Respiratory and Critical Care Medicine

DOI 10.1164/rccm.201402-0385ciPMC PMC4061901

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Abstract

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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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
DOI: 10.1164/rccm.201402-0385ci
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
Licence: academic.oup.com/pages/standard-publication-reuse-rights (vor)
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

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Macrolide Antibiotics and the Risk of Cardiac Arrhythmias

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