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Azithromycin: Risks of QT Prolongation, Digestive Reactions, and Drug Interactions in Macrolides

Image of a middle-aged Hispanic physician in a modern medical office, examining a tablet displaying an electrocardiogram with a prolonged QT interval. On the desk, there is a box of azithromycin tablets. This image highlights the risks of QT prolongation associated with azithromycin use, including potential digestive reactions and drug interactions.

Azithromycin, an antibiotic belonging to the macrolides family, is widely used in clinical practice to treat various bacterial infections. However, its use is not without risks, particularly concerning QT prolongation on the electrocardiogram, an adverse effect that can predispose patients to potentially fatal arrhythmias such as torsade de pointes. Additionally, azithromycin may cause other adverse reactions, including digestive effects and drug interactions.

Diving Deeper into the Risks of Azithromycin

The concern regarding QT prolongation with azithromycin use has been the subject of multiple studies. A retrospective analysis of cases of torsade de pointes associated with azithromycin revealed a significant increase in the disproportionality of reports of this adverse effect [1]. Furthermore, the combination of azithromycin with other medications, such as hydroxychloroquine, has shown an increased risk of QT prolongation, especially in the context of COVID-19 treatment [2].

In a pharmacovigilance study, it was observed that azithromycin, when combined with antimalarials, presents concerning safety signals for QT prolongation and torsade de pointes [3]. This risk is exacerbated in patients with predisposing factors such as concomitant use of loop diuretics or a baseline elevated QTc [4].

In addition to cardiac risks, azithromycin can cause digestive reactions such as diarrhea and vomiting, which are the most commonly reported adverse effects in pediatrics [5]. The incidence of these effects is higher with medium to high doses of the medication.

Conclusions

Azithromycin remains a valuable tool in the therapeutic arsenal against bacterial infections, but its use must be carefully evaluated in patients at risk for QT prolongation. It is crucial to conduct appropriate electrocardiographic monitoring and consider drug interactions that may increase this risk. Physicians should be vigilant for digestive reactions and other potential adverse effects, adjusting treatment as necessary to minimize risks to the patient.

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Created 6/1/2025