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Life-threatening bradyarrhythmia after massive azithromycin overdose.
John A Tilelli1, Kathleen M Smith, Robert Pettignano
1Nemours Children's Clinic and Arnold Palmer Hospital for Children and Women, Orlando, Florida 32806, USA. tilelli@ pegasus.cc.ucf.edu
Pharmacotherapy
|March 2, 2006
Summary
An infant experienced cardiac arrest after an azithromycin overdose. This case highlights the risk of severe bradycardia and heart block with intravenous azithromycin, even without drug interactions.
Area of Science:
- Pharmacology
- Pediatric Cardiology
Background:
- Azithromycin is a macrolide antibiotic commonly used in pediatric care.
- Macrolide antibiotics, including azithromycin, are known to cause QT interval prolongation and Torsade de Pointes.
Observation:
- A 9-month-old infant received an accidental overdose of intravenous azithromycin (50 mg/kg) instead of ceftriaxone.
- The infant became unresponsive and pulseless, presenting with wide-complex bradycardia, complete heart block, and a prolonged QT interval.
Findings:
- Despite resuscitation efforts, the infant suffered severe anoxic encephalopathy.
- This case represents the first reported instance of bradycardia with complete heart block specifically linked to intravenous azithromycin overdose in isolation.
Implications:
- Clinicians must be aware of the potential for azithromycin to induce life-threatening bradycardia and heart block.
- Enhanced pharmacy protocols are crucial for safe azithromycin administration, particularly from point-of-care sources, to prevent medication errors and adverse events.