M. Strambabadiale et al., QT INTERVAL PROLONGATION AND RISK OF LIFE-THREATENING ARRHYTHMIAS DURING TOXOPLASMOSIS PROPHYLAXIS WITH SPIRAMYCIN IN NEONATES, The American heart journal, 133(1), 1997, pp. 108-111
We recently reported two cases of QT interval prolongation and cardiac
arrest in newborns receiving antibiotic therapy with spiramycin, a ma
crolide agent extensively used for toxoplasmosis prophylaxis. In this
study we assessed the effects of this drug on ventricular repolarizati
on and on the potential risk of lethal arrhythmias in eight newborn in
fants in whom toxoplasmosis prophylaxis after birth was necessary. Ele
ctrocardiograms (ECGs) and echocardiograms were recorded during spiram
ycin therapy (350,000 IU/kg/day) and after its withdrawal. In a contro
l group of eight healthy newborns matched for age and sex, no differen
ces were found between two ECGs analogously recorded. The QT interval
corrected for heart rate (QTc) was longer during spiramycin therapy th
an after drug withdrawal (448 +/- 32 msec vs 412 +/- 10 msec, +9%, p =
0.021). QTc dispersion, expressed as the difference between the longe
st and the shortest value in 12 different leads (QTc(max - min)), was
also higher during spiramycin therapy (60 +/- 32 msec vs 34 +/- 8 msec
, +76%, p 0.021), mainly because of a major lengthening of the longest
QTc (QTc(max)). QTc and QTc dispersion were markedly increased in the
two newborns who experienced cardiac arrest after beginning treatment
compared with the six neonates who had no drug-induced symptoms. Duri
ng therapy seven of eight newborns had a rare abnormality in the thick
ening of the left ventricular posterior wall similar to that observed
in patients with congenital long QT syndrome. This abnormality disappe
ared after drug withdrawal. Thus antibiotic therapy with spiramycin in
the neonatal period may induce QT interval prolongation and increase
QT dispersion. When this effect on ventricular repolarization is more
marked, it may favor the occurrence of torsades des pointes and lead t
o cardiac arrest.