Suspected cardiotoxicity of clarithromycin in critically ill patients

Abstract

Clarithromycin, a macrolide antibiotic is known to have an arrhythmogenic potential in the presence of comparable QT prolongation. Indeed, the extent of QT prolongation hasbeen used as a surrogate marker for cardiotoxicity and sudden cardiac death. We report a case series of three adult patients who were transferred to our intensive care unit (ICU) at Peradeniya Teaching Hospital, Peradeniya (Sri Lanka), and needed inotropic support and mechanical ventilation. All the three of them were treated with a standard dose regimen of intravenous clarithromycin for suspected atypical pneumonia, after which they dramatically deteriorated and unexpectedly died within 72 hours. In the absence of other known precipitating factors, cardiotoxicity of clarithromycin was suspected as the main causative factor for these deaths.