Ciprofloxacin does not Prolong the QTc Interval: A Clinical Study in ICU Patients and Review of the Literature

Abstract

Summary -Purpose. Ciprofloxacin may prolong the QT interval and increase the risk of Torsade de Pointes (TdP). Intravenous administration of ciprofloxacin in patients with additional risks may elevate the risk of QTc interval prolongation. We prospectively assessed whether intravenous ciprofloxacin prolongs the QT interval in patients with additional co-morbidities and risk factors. We also reviewed the literature on the QT prolonging effect or TdP inducing effect of ciprofloxacin. Methods. ICU Patients who were treated with intravenous ciprofloxacin as part of their therapy were recruited. ECG was recorded within 60 min before start and in the last 30 min of 1 h infusion, or within 30 min after the end of ciprofloxacin infusion. QT interval was corrected for the heart rate using both Bazett's and Fridericia's formula. The changes were analyzed using the paired Student's t-test. Results. Ten patients were included in the study (average age 74-y, 6 males). The average baseline QTc interval corrected with Bazett's formula was 448 ms that was shortened during or after ciprofloxacin infusion by 3 ms and 2 ms based on Bazett's (p=0.67) and Fridericia's (p=0.68) formula, respectively. No observational study or cohort study thus far has shown that ciprofloxacin has a QT prolonging effect or increases the risk of TdP or (cardiovascular) mortality. Conclusion. Based on our results and the results of previous studies, it is unlikely that ciprofloxacin has a clinically relevant QT prolonging effect or an increased risk of TdP.

Fluoroquinolone antibiotics: safety of use by the example of ciprofloxacin

“…Таким образом, ципрофлоксацин, согласно актуальной информации, представляет собой фторхинолон с самым низким среди препаратов этой группы риском удлинения интервала QT [29,30]. По данным фармакоэпидемиологических исследований, ципрофлоксацин связывают с подобным синдромом в 0,3 случаев на 10 млн назначений, тогда как левофлоксацин -в 16 случаях, гатифлоксацин -в 27 случаях [19].…”

“…По данным фармакоэпидемиологических исследований, ципрофлоксацин связывают с подобным синдромом в 0,3 случаев на 10 млн назначений, тогда как левофлоксацин -в 16 случаях, гатифлоксацин -в 27 случаях [19]. В пользу отсутствия статистически значимого увеличения числа аритмий при монотерапии ципрофлоксацином бактериальных инфекций, в том числе у пациентов отделения интенсивной терапии в возрасте 60-85 лет, свидетельствуют результаты обзора литературы и клинического исследования, проведенных в 2017 г. голландскими исследователями [30].…”

Effect of ciprofloxacin vs levofloxacin on QTc‐interval and dysglycemia in diabetic and non‐diabetic patients

“…Twelve lead Nihon Kohden's Cardiofax C electrocardiogram (Rosbach, Germany) and fasting blood glucose tests were obtained from each patient before starting antibiotic, after 24 hours, 72 hours from the first dose, and after 72 hours from antibiotic cessation. 22,23 QTc was automatically calculated by ECG device using Bazett's formula where QTc = QT/√(RR). 24 The borderline QTc range is 430-450 msec in males and 450-470 ms in females.…”

Loading and releasing ciprofloxacin in photoactivatable liposomes

“…Fluoroquinolones have been associated with heart abnormalities including Torsades de Pointus (TdP) which is a rare but lethal form of polymorphic ventricular tachycardia. There are reports on TdP associated with CIP [52]. It has also been suggested that CIP administration may contribute to tendon disorders [53].…”