and qt Exam 2: Macrolides, Fluoroquinolones, Antimycobacterial Pharmacology. Fluoroquinolones can cause QT prolongation and, thus, predispose a person to Torsades de Pointes which is sometimes fatal. Fluoroquinolones have traditionally been considered to be contraindicated in children because they may cause cartilage lesions if growth plates are open. fluoroquinolones, clofazimine, pretomanid, The average QT prolongation associated with fluoroquinolones has little effect against normal QT interval, but the risk of developing TdP is greater in a patient with pre-existing QT interval prolongation due to hypokalemia, hypomagnesemia, heart failure, arrhythmia, or other medications. QT PROLONGATION The QT prolongation from torsades de pointes can be life-threatening. for drugs causing QT prolongation Cipro belongs to a class of antibiotics called fluoroquinolones. Moxifloxacin is currently under observation concerning QTc effects. Free Online Library: Identifying patients at risk for QT interval prolongation: case studies. Sotalol is a bêta-blocker and class 3 anti-arrhythmic. Am J Med 123 (2010): e5-6. The discovery, development and clinical use of fluoroquinolone antibiotics in the last century contributed to a decline in morbidity and mortality rates. d . QT Interval Prolongation and Antiretroviral Treatment: Another Point of Interest To THE EDITOR-In their recent brilliant article, Owens and Nolin [1] described how the QT interval can be prolonged by use of antimicrobials, such as macrolides and ketolides, certain fluoroquinolones and antimalarials, pentamidine, and the azole antifungals. Prolongation of the corrected QT interval (QTc) may precipitate fatal ventricular arrhythmias such as torsades de pointes. Less common but more severe side effects include QT prolongation, seizures, hallucinations, tendon rupture, angioedema and photosensitivity. Both drugs have a common adverse effect : they increase QT interval with a risk of torsade de pointe. ciprofloxacin Lfx and Ofx have a lower risk of QT prolongation. 5 For example, the first two nonsedating antihistamines—terfenadine (Seldane, Hoechst Marion Roussel) and astemizole (Hismanal, Janssen)—were approved by the Food and Drug … Find patient medical information for ciprofloxacin oral on WebMD including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Fluoroquinolones. The prolonged QT interval is both widely seen and associated with the potentially deadly rhythm, Torsades de Pointes (TdP). Both macrolides and fluoroquinolones have QT prolongation listed under the prescribing information’s warnings and precautions, and fluoroquinolones have several additional warnings, including aortic aneurysm, tendinitis or tendon rupture, peripheral neuropathy, and central nervous system effects. Sparfloxacin is associated with cardiac manifestations of QTc prolongation and has a high phototoxicity potential. Clostridium difficile colitis. torsades de pointes associated with non-cardiac drugs that prolong the QT interval. Tendonitis and tendon rupture. [1] They comment on the fluoroquinolone antimicrobial agents grepafloxacin and sparfloxacin causing QT prolongation but also the apparent lack of this effect with levofloxacin. Black box … Members of fluoroquinolones class have different effects on QT interval. Inhibit protein synthesis by binding to 23S rRNA on the 50S ribosomal subunit and blocking translocation. Key Points. getting some definitions straight Polymorphic ventricular tachycardia. So, here is a mnemonic for drugs causing QT prolongation. However, cardiac adverse effects has been developed with fluoroquinolones still in market. Drugs Commonly Associated with QT Prolongation Antiarrhythmic agents were the first drugs associated with QT prolongation and ventricular arrhythmias. Ciprofloxacin is a fluoroquinolone antibiotic used against Gram - germs. Avoid use in patients with known prolongation, those with hypokalemia, and with other drugs that prolong the QT interval. Some fluoroquinolones, including LEVAQUIN ®, have been associated with prolongation of the QT interval on the electrocardiogram and infrequent cases of arrhythmia. 80. Fluoroquinolones. Prolonged QTc interval >500 milliseconds is associated with an increased risk for Torsades de Pointes, a life-threatening cardiac arrhythmia. With widespread use, antimicrobial resistance to fluoroquinolones has grown. The common side effects of the fluoroquinolones are gastrointestinal disturbances, headaches, skin rash and allergic reactions. Levofloxacin has no QTc prolongation and a very low phototoxic potential, making it one of the safest new fluoroquinolones. Fluoroquinolones:-Frequency not reported: Attacks of porphyria . Cases of torsade de pointes have been reported during postmarketing surveillance in patients receiving The US FDA suggested that the … A – Anti A rrhythmics (Amiodarone, Sotalol, Flecainide) A – Anti A nginals (Ranolazine) B – Anti B iotics (Fluoroquinolones, Macrolides, Aminoglycosides) C – Anti C ychotics (Haloperidol, Quetiapine, Risperidone) D – Anti D epressants (SSRIs, TCAs) (5.12, 7, 8.5) NDA 19537 20780 Cipro Tablets and OS FDA Approved March 2021 Reference ID: 4770634 Fluoroquinolones: Mfx causes the greatest QT prolongation. Currently, no standardized TDM range has been proposed. Headache. Lowering the seizure threshold. The risk of QTc prolongation is increased when administered with fluoroquinolones and in hypoalbuminemic patients. fluoroquinolones, QT interval, QT prolongation, torsades de pointes, side effects Fluoroquinolones (FQs) have been widely employed for the treatment of bacterial infections for nearly 25 years. The newer fluoroquinolones have broad-spectrum bactericidal activity, excellent oral bioavailability, good tissue penetration and favorable safety and tolerability profiles. Prolongation of the QT interval can lead to torsades de pointes, a life-threatening arrhythmia, but in practice this appears relatively uncommon in part because the most widely prescribed fluoroquinolones (ciprofloxacin and levofloxacin) only minimally prolong the QT interval. Prolongation of the QT interval can lead to torsades de pointes, a life-threatening arrhythmia, but in practice this appears relatively uncommon in part because the most widely prescribed fluoroquinolones (ciprofloxacin and levofloxacin) only minimally prolong the QT interval. In patients with no evidence of cardiac dysfunction, a QTc of > 440 ms can be associated with a 2.3 times higher risk for sudden death compared with a QTc of < 440 ms. Drug interactions involving the inhibition of metabolism have contributed to the removal of a number of medications from the U.S. market. Cipro is effective for treating infections caused by many different types of bacteria. 5.12 Prolongation of the QT Interval Some fluoroquinolones, including ciprofloxacin, have been associated with prolongation of the QT interval on the electrocardiogram and cases of arrhythmia. Fluoroquinolones are divided into 2 groups, based on antimicrobial spectrum and pharmacology: Older group: Ciprofloxacin, norfloxacin, and ofloxacin. Avoid use in patients with known prolongation, interval (5.9, 8.5) 17 . This is a problem since susceptibility to QTc-prolongation and potential for developing TdP depends greatly on the number and type of risk factors. Newer group: Delafloxacin, gemifloxacin, levofloxacin, and moxifloxacin. This antibiotic treats only bacterial infections. Fluoroquinolones have previously been associated with a small increased risk of aortic ... and arrhythmia, including for patients with a history of QT interval prolongation or ventricular arrhythmia and patients with electrolyte disturbances. § “QTc” denotes the QT interval corrected for a patient’s heart rate.2 § QTc prolongation can precipitate to torsades de pointes (TdP), a life-threatening ventricular tachyarrhythmia that results in sudden death.1 § It is due to genetic susceptibility and medications.1 § Clinical significance of QTc prolongation is underestimated and Ventricular arrhythmia and torsade de pointes have been reported, mainly in patients with risk factors of QT prolongation. Disabling and potentially permanent side effects lead to suspension or restrictions of quinolone and fluoroquinolone antibiotics. Explain why ondansetron and droperidol together do not affect QTc prolongation much. Fluoroquinolones:-Frequency not reported: Attacks of porphyria . Fluoroquinolones are highly effective antibiotics with many advantageous pharmacokinetic properties including high oral bioavailability, large volume of distribution, and broad-spectrum antimicrobial activity. In fact, about 90% of drug interaction-induced TdP occur in patients with ≥ 1 risk factor, and 74% of cases have ≥ 2 risk factors.1 QT PROLONGATION, TDP, AND THE FDA. The post-marketing surveillance pointed out the favorable side effects associated with fluoroquinolones such as phototoxicity, QT interval prolongation and anaphylaxis. While it can occur spontaneously in the congenital form, there is a wide array of drugs that have been implicated in the prolongation of the QT interval. Higher affinity for 50S subunit due to additional binding site on 23S rRNA. 5 For example, the first two nonsedating antihistamines—terfenadine (Seldane, Hoechst Marion Roussel) and astemizole (Hismanal, Janssen)—were approved by the Food and Drug … ZOLOFT posologie : découvrez les indications, pour grossesse, femme enceinte, bébé, enfant, alcool ainsi que l’avis d’un expert ! The two fluoroquinolones most likely to cause QT prolongation have been removed from the market, but experts recommend avoiding moxifloxacin and levofloxacin in patients with known QT interval prolongation, hypokalemia, and hypomagnesemia. Link: Linking Learning to Practice for MAINPRO-C credit (self learning activity, CCFP). ZOLOFT posologie : découvrez les indications, pour grossesse, femme enceinte, bébé, enfant, alcool ainsi que l’avis d’un expert ! QT dispersion (QTd) may be a more selective marker of Tdp. Mnemonics make this task easy. QTc prolongation ... fluoroquinolones) - bedaquiline - triazole antifungal agents quinidine, procainamide) or class III (e.g. Methods of evaluating this risk are varied and not systematic. Drugs Commonly Associated with QT Prolongation Antiarrhythmic agents were the first drugs associated with QT prolongation and ventricular arrhythmias. Patients receiving bedaquiline in clinical trials, case reports or cohort studies often received concomitant anti-TB drugs with an increased risk of QTc prolongation, i.e. This is commonly referred to as torsade de pointes, but it's actually not the same thing. (Fluoroquinolones and QT interval prolongation) by "Journal of Family Practice"; Health, general Antibacterial agents Usage Arrhythmia Case studies Risk factors Heart diseases Long QT syndrome Quinolone antibacterial agents Quinolones The potential risk of QT prolongation should be placed in appropriate context when choosing an antibacterial drug: Alternative drugs in the macrolide or … Rash. Prolonged QTc Interval >500 ms in males and females A QTc interval >500 ms is clinically significant and likely to confer an increased risk of arrhythmia. This prolongation increases slowly over time in the first 6 to 10 weeks of treatment and remains stable therafter. Defined as ventricular tachycardia with varying QRS amplitude. getting some definitions straight Polymorphic ventricular tachycardia. Although the overall risk of QT prolongation is minimal, avoid (if possible) or monitor combination of FQs with other drugs that prolong QT interval. Fluoroquinolones Ciprofloxacin Moxifloxacin Levofloxacin GI upset (nausea, vomiting, diarrhea) Neurologic (dizziness, AMS, seizures) Phototoxicity Tendonitis, cartilage erosion QT prolongation Dysglycemia Peripheral neuropathies Caution with cations (reduced bioavailability) Inhibits 1A2 (cipro) QT PROLONGATION, TDP, AND THE FDA. 6,7 QTc Interval Prolongation: Patients treated with TIBSOVO can develop QT (QTc) prolongation and ventricular arrhythmias. assessing the patient’s risk of QTc-prolongation and TdP. Drug reported in the product labelling to prolong the QT interval, but evidence to support such an effect is lacking or published data suggest otherwise. The potential risk of QT prolongation should be placed in appropriate context when choosing an antibacterial drug: Alternative drugs in the macrolide or … Fluoroquinolones prolong the heart's QT interval by blocking voltage-gated potassium channels. Avoid use in patients with known prolongation, interval (5.9, 8.5) 79. Fluoroquinolone class is associated with cardiac side effects as QTc prolongation. QTc Interval Prolongation: Patients treated with TIBSOVO can develop QT (QTc) prolongation and ventricular arrhythmias. Cardiovascular. The common side effects of the fluoroquinolones are gastrointestinal disturbances, headaches, skin rash and allergic reactions. Delafloxacin does not appear to cause significant prolongation of the QT interval. Both macrolides and fluoroquinolones have QT prolongation listed under the prescribing information’s warnings and precautions, and fluoroquinolones have several additional warnings, including aortic aneurysm, tendinitis or tendon rupture, peripheral neuropathy, and central nervous system effects. • QT Prolongation: Prolongation of the QT interval and isolated cases of torsade de pointes have been reported. Polymorphic ventricular tachycardia may be caused by several etiologies (e.g., congenital QT prolongation, acquired QT prolongation, ischemia, … F. T/F: Quinolone and Azole combinations should be avoided because of the severe QT prolongation. It will not work for virus infections (such as common cold, flu).Unnecessary use or overuse of any antibiotic can lead to its decreased … Fluoroquinolones prolong the heart's QT interval by blocking voltage-gated potassium channels. GI and neuro toxicity. This prolongation increases slowly over time in the first 6 to 10 weeks of treatment and remains stable therafter. On 15 November 2018, EMA finalised a review of serious, disabling and potentially permanent side effects with quinolone and fluoroquinolone antibiotics given by mouth, injection or inhalation. Nice work! Am J Med 123 (2010): e5-6. Drug interactions involving the inhibition of metabolism have contributed to the removal of a number of medications from the U.S. market. An abnormally long or abnormally short QT interval is … The newer fluoroquinolones have broad-spectrum bactericidal activity, excellent oral bioavailability, good tissue penetration and favorable safety and tolerability profiles. QT prolongation – moxifloxacin most associated with this. • QT Prolongation: Prolongation of the QT interval and isolated cases of torsade de pointes have been reported. QT prolongation, allergic reaction Consider periodic LFTs with prolonged use; baseline Cr with clarithromycin (dose-adjustment assessment) Hypersensitivity, GI effects, drug interactions, QT prolongation with risk factors Metronidazole Nausea, diarrhea, disulfiram-like reactions with alcohol, metallic taste, reversible neutropenia It works by stopping the growth of bacteria.. Cipro belongs to a class of antibiotics called fluoroquinolones. Kelesidis T, Canseco E "Quinolone-induced hypoglycemia: a life-threatening but potentially reversible side effect." Avoid use in patients with known prolongation, those with hypokalemia, and with other drugs that prolong the QT interval. Last but not least, remember that fluoroquinolones can cause QT prolongation, increasing the risk of Torsades de Pointes. Similar mechanism of action to Macrolide. A QTc interval of 440 ms is considered by many to be the upper limit of normal. Factors that predispose to QT prolongation and higher risk of torsades de pointes include older age, female sex, low left ventricular ejection fraction, left ventricular hypertrophy, ischemia, slow heart rate, and electrolyte abnormalities including hypokalemia and hypomagnesemia. If that was the case, the prevalence of a prolonged QTc interval caused by ciprofloxacin and … Sparfloxacin carries a significant risk of phototoxicity.21, 23 Grepafloxacin, sparfloxacin and moxifloxacin have been reported to cause prolongation of the QT interval; gatifloxacin has not. Hematologic toxicity. This drug was associated with 13 cases of torsade de pointes reported to the FDA between 1996 and 2001. Fluoroquinolones, including LEVAQUIN ® , are associated with an increased risk of tendinitis and tendon rupture in all ages. obtained QTc normalisation after receiving verapamil [47], while the other patient presented spontaneous normalisation of QTc [44]. Cardiology 120 (2011): 103-110. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT. Find patient medical information for ciprofloxacin oral on WebMD including its uses, side effects and safety, interactions, pictures, warnings and user ratings. QT-interval prolongation by erythromycin Inhibition of hepatic metabolism, leading to numerous drug interactions Erythromycin commonly causes dose-related GI disturbances, including nausea, vomiting, abdominal cramps, and diarrhea; disturbances are … The most common type of acquired QTc interval prolongation is caused by drugs. An abnormally long or abnormally short QT interval is … Cardiology 120 (2011): 103-110. Any drugs which prolong the QT interval should be reviewed immediately. 78. Fluoroquinolones classified based on QT prolongation risk. fluoroquinolones, including CIPRO XR, in patients who ... • QT Prolongation: Prolongation of the QT interval and isolated cases of torsade de pointes have been reported. 80. Reactions 1334 - 15 Jan 2011 Fluoroquinolones classified based on QT prolongation risk In light of discrepancies noted between the current summaries of product characteristics (SmPCs) for some products and the recommendations set forth by the EMA’s Pharmacovigilance … Grepafloxacin was removed from the market due to frequent QT prolongation. Fluoroquinolones and risk of QT-interval prolongation January 2011 Page 1/5 Briasoulis A, Agarwal V, Pierce WJ "QT Prolongation and Torsade de Pointes Induced by Fluoroquinolones: Infrequent Side Effects from Commonly Used Medications." Some fluoroquinolones, including LEVAQUIN ®, have been associated with prolongation of the QT interval on the electrocardiogram and infrequent cases of arrhythmia. Avoid use in patients with known prolongation, those with hypokalemia, and with other drugs that prolong Effects of Three Fluoroquinolones on QT Analysis After Standard Treatment Courses ... respect to QTc prolongation.9,11 12 Ciprofloxacin has displayed little, if any, QTc change while mox-ifloxacin repeatedly prolongs the QTc between 6 and 16 ms. Levofloxacin has shown variable pro- Fluoroquinolones are associated with their own range of potential side effects. Cardiovascular. Depression/Suicidality. Abstract. lengthening of the QT interval, the electrocardiographic interval that shows ventricular repolarization (4). Ciprofloxacin belongs to a class of drugs called quinolone antibiotics. The prolonged QT interval is both widely seen and associated with the potentially deadly rhythm, Torsades de Pointes (TdP). Therefore, they should be avoided in patients with known prolongation of the QT interval, patients with uncorrected hypokalaemia or hypomagnesaemia and patients receiving class IA (e.g. Hyper/hypoglycemia. 78. Delafloxacin does not appear to cause significant prolongation of the QT interval. Briasoulis A, Agarwal V, Pierce WJ "QT Prolongation and Torsade de Pointes Induced by Fluoroquinolones: Infrequent Side Effects from Commonly Used Medications." It will not work for virus infections (such as common cold, flu).Unnecessary use or overuse of any antibiotic can lead to its decreased … Describes whether the FDA-approved product labelling includes mention of QT prolongation, torsades de pointes, or both. Prolongation of the corrected QT interval (QTc) may precipitate fatal ventricular arrhythmias such as torsades de pointes. Fluoroquinolones can cause QT interval prolongation. While it can occur spontaneously in the congenital form, there is a wide array of drugs that have been implicated in the prolongation of the QT interval. Warnings have also been strengthened QT prolongation QT prolongation has been observed in patients treated with delamanid. 470 ms. TdP Prevention: avoid in male pts with pre-tx QTc > 480 ms. 79. Although the rhythm is often self-limiting, there is potential to progress to ventricular fibrillation or sudden cardiac death (5). Fluoroquinolones can cause arrhythmias due to QT prolonging effects that may be augmented if given together with any of the multiple other drugs, such as amiodarone, that cause QT prolongation. This is commonly referred to as torsade de pointes, but it's actually not the same thing. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT. 2.1.8. Kelesidis T, Canseco E "Quinolone-induced hypoglycemia: a life-threatening but potentially reversible side effect." Fluoroquinolones, including LEVAQUIN ® , are associated with an increased risk of tendinitis and tendon rupture in all ages. Fluoroquinolones may lead to prolonged QT intervals due to inhibition of potassium channels . Ciprofloxacin belongs to a class of drugs called quinolone antibiotics. The QT interval is a measurement made on an electrocardiogram used to assess some of the electrical properties of the heart.It is calculated as the time from the start of the Q wave to the end of the T wave, and approximates to the time taken from when the cardiac ventricles start to contract to when they finish relaxing. amiodarone, sotalol) antiarrhythmic agents. Introduction Several fluoroquinolone antibiotics have been associated with cardiac adverse effects, leading to the withdrawal of some of these agents from the market. Cardiac side effects such as QT prolongation and torsades de pointes (TdP) have also been observed with fluoroquinolones currently on the market. Fluoroquinolones can cause QT interval prolongation. Defined as ventricular tachycardia with varying QRS amplitude. Less common but more severe side effects include QT prolongation, seizures, hallucinations, tendon rupture, angioedema and photosensitivity. QT-interval prolongation by erythromycin Inhibition of hepatic metabolism, leading to numerous drug interactions Erythromycin commonly causes dose-related GI disturbances, including nausea, vomiting, abdominal cramps, and diarrhea; disturbances are … Cipro is effective for treating infections caused by many different types of bacteria. QTc prolongation ... fluoroquinolones) - bedaquiline - triazole antifungal agents Side effects with fluoroquinolones include: Gastrointestinal effects – nausea, abdominal pain, diarrhea. Drug Names. QT prolongation, allergic reaction Consider periodic LFTs with prolonged use; baseline Cr with clarithromycin (dose-adjustment assessment) Hypersensitivity, GI effects, drug interactions, QT prolongation with risk factors Metronidazole Nausea, diarrhea, disulfiram-like reactions with alcohol, metallic taste, reversible neutropenia Therefore, in patients with QTc prolongation and without a baseline ECG available, the prolonged QTc interval could have been pre-existing. (5.12, 7, 8.5) NDA 19537 20780 Cipro Tablets and OS FDA Approved March 2021 Reference ID: 4770634 One fluoroquinolone drug in particular, ciprofloxacin, is a potent inhibitor of CYP enzymes and is well known to cause drug interactions. The following may increase the risk for QT prolongation when patients are receiving SIRTURO: • use with other QT prolonging drugs including fluoroquinolones and macrolide antibacterial drugs and the antimycobacterial drug, clofazimine It works by stopping the growth of bacteria.. Link: Linking Learning to Practice for MAINPRO-C credit (self learning activity, CCFP). This risk is ... • Prolongation of the QT interval and isolated cases of torsade de pointes have been reported. amiodarone, sotalol) antiarrhythmic agents. This drug was associated with 13 cases of torsade de pointes reported to the FDA between 1996 and 2001. Fluoroquinolones, including LEVAQUIN, are associated ... • Prolongation of the QT interval and isolated cases of torsade de pointes have been reported. Polymorphic ventricular tachycardia may be caused by several etiologies (e.g., congenital QT prolongation, acquired QT prolongation, ischemia, … The QT interval is a measurement made on an electrocardiogram used to assess some of the electrical properties of the heart.It is calculated as the time from the start of the Q wave to the end of the T wave, and approximates to the time taken from when the cardiac ventricles start to contract to when they finish relaxing. QTc interval (QTc) prolongation is the most commonly used marker of Tdp, but has questionable utility. QT prolongation. Common adverse effects. a QT-study according to the ICH E14, any future SPC for gemifloxacin should be similar to the moxifloxacin one regarding the risk of QT interval prolongation. Ciprofloxacin is used to treat a variety of bacterial infections. 6,7 In the past decade, prolongation of the QT interval associated with polymorphic ventricular tachycardia, or torsades de pointes (TdP), has accounted for the majority of withdrawals or restriction of the use of prescription drugs from the U.S. market. Ciprofloxacin is used to treat a variety of bacterial infections. Therefore, they should be avoided in patients with known prolongation of the QT interval, patients with uncorrected hypokalaemia or hypomagnesaemia and patients receiving class IA (e.g. Rare cases of torsade de pointes have been spontaneously reported during postmarketing surveillance in patients receiving fluoroquinolones, including LEVAQUIN ® . QT prolongation QT prolongation has been observed in patients treated with delamanid. In addition, care should be to keep electrolytes within normal range. Some agents of fluoroquinolones were withdrawn from market. Rare cases of torsade de pointes have been spontaneously reported during postmarketing surveillance in patients receiving fluoroquinolones, including LEVAQUIN ® . Fluoroquinolones Ciprofloxacin Moxifloxacin Levofloxacin GI upset (nausea, vomiting, diarrhea) Neurologic (dizziness, AMS, seizures) Phototoxicity Tendonitis, cartilage erosion QT prolongation Dysglycemia Peripheral neuropathies Caution with cations (reduced bioavailability) Inhibits 1A2 (cipro) Fluoroquinolones have traditionally been considered to be contraindicated in children because they may cause cartilage lesions if growth plates are open. 2–65. Fluoroquinolones, including LEVAQUIN, are associated ... • Prolongation of the QT interval and isolated cases of torsade de pointes have been reported. In order to evaluate the cardiac risk … quinidine, procainamide) or class III (e.g. Some members of the quinolone family are more likely to causes an increased QT than others. This risk is ... • Prolongation of the QT interval and isolated cases of torsade de pointes have been reported. Background: Fluoroquinolone (FQ) agents have been speculated to influence the risk of Torsades de pointes (Tdp). Clostridium difficile-associated diarrhea Both macrolides and fluoroquinolones have QT prolongation listed under the prescribing information's warnings and precautions, and fluoroquinolones have several additional warnings, including aortic aneurysm, tendinitis or tendon rupture, peripheral neuropathy, and central nervous system effects Outpatient Setting: The potential risk of QT prolongation should be placed in appropriate context when choosing an antibacterial drug: Alternative drugs in the macrolide or … This antibiotic treats only bacterial infections. Ventricular arrhythmia and torsade de pointes have been reported, mainly in patients with risk factors of QT prolongation.