Effect of triple antimicrobial therapy on electrocardiography parameters in patients with mild-to-moderate
Burcu Uğurlu Ilgın1, İrem Müge Akbulut Koyuncu2, Emrullah Kızıltunç3
1Department of Cardiology, Gazi Mustafa Kemal State Hospital; Ankara-Turkey.
Insights
Triple therapy for COVID-19, including hydroxychloroquine, an antiviral, and an antibiotic, significantly altered electrocardiogram (ECG) parameters. While QTc and QRS duration increased, QTc dispersion decreased with azithromycin, and no ventricular arrhythmias occurred.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- The impact of triple combination therapy for COVID-19 on cardiac function remains incompletely understood.
- Electrocardiography (ECG) parameters are crucial for monitoring potential drug-induced cardiac side effects.
Purpose of the Study:
- To investigate the effects of triple therapy (hydroxychloroquine + antiviral + antibiotic) on ECG parameters in mild-to-moderate COVID-19 patients.
- To compare the cardiac effects of azithromycin versus levofloxacin as part of the triple therapy.
Main Methods:
- Retrospective analysis of 91 mild-to-moderate COVID-19 patients.
- Patients received either hydroxychloroquine+oseltamivir+azithromycin (Group 1) or hydroxychloroquine+oseltamivir+levofloxacin (Group 2).
- Comprehensive ECG parameters were measured at baseline and post-treatment.
Main Results:
- Significant increases in QTc, QRS duration, Tp-e, PR interval, and P wave duration were observed post-treatment.
- QTc prolongation occurred in both groups, with significant QTc interval and QRS duration prolongation in both.
- QTc dispersion (QTD) significantly decreased in the azithromycin group (Group 1).
Conclusions:
- Triple therapy for COVID-19 significantly impacts ECG parameters, notably prolonging QTc and QRS duration.
- The use of azithromycin in triple therapy was associated with a significant decrease in QTc dispersion.
- No overt ventricular arrhythmias were observed, suggesting a manageable safety profile regarding arrhythmias.
Objective:
The effects of treatment of coronavirus disease 2019 (COVID-19) with a triple combination composed of hydroxychloroquine, an an-tiviral, and an antibiotic on electrocardiography (ECG) parameters in patients with mild-to-moderate symptoms are not wholly understood. We aimed to explore the changes in ECG parameters after treatment with triple combination therapy in patients with mild-to-moderate symptomatic COVID-19.
Methods:
This retrospective, single-center case series analyzed 91 patients with mild-to-moderate symptomatic COVID-19 at Ankara Gazi Mus-tafa Kemal State Hospital of Ankara City, Turkey, from April 1, 2020, to April 30, 2020. Forty-three patients were treated with hydroxychloroquine+oseltamivir+azithromycin (Group 1) and 48 patients were treated with hydroxychloroquine+oseltamivir+levofloxacin (Group 2). Heart rate, P wave duration, P wave dispersion, PR interval, QRS duration, corrected QT interval (QTc), QTc dispersion (QTD), delta QTc, Tp-e, Tp-e dispersion, and Tp-e/QTc ratio were all calculated from the baseline and posttreatment 12-lead ECG recordings.
Results:
The QTc, QRS duration, Tp-e, PR interval, and P wave duration were significantly increased after treatment (p<0.001; p<0.001; p<0.001; p=0.001; p=0.001). The posttreatment C-reactive protein level was significantly lower than at baseline in Group 1 (p=0.014). At admission, 30% of patients had QT prolongation, and 4.3% of them had a QT duration >500 ms. Both Group 1 and Group 2 showed significant prolongation of the QTc interval (Group 1; p<0.001 vs. Group 2; p<0.001), QRS duration (Group 1; p=0.006 vs. Group 2; p=0.014), Tp-e (Group 1; p=0.036 vs. Group 2; p<0.001), and PR interval (Group 1; p=0.002 vs. Group2; p=0.05). The QTD was significantly decreased in Group 1 (p<0.001). None of the patients experienced any overt ventricular arrhythmia.
Conclusion:
To the best of our knowledge, this study is the first to investigate QT prolongation in a population of COVID-19 patients treated with triple combination therapy. We found that there was a significant decrease in the QTD after the treatment in patients who were taking triple therapy including azithromycin.
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