Antimicrobial Agents-induced Torsade De Pointes: Literature Analysis of 16 Cases_West China Medical Journal

Authors：

XIAO Guirong , WU Fengbo , TANG Yao

Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

Keywords：

抗菌药物; 尖端扭转型室速; 不良反应

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【摘要】　目的　探讨抗菌药物诱导尖端扭转型室速（torsade de pointes，TDP）的规律及特点，为临床合理用药提供参考。　方法　检索中国期刊全文数据库、维普、万方、中国生物医学文献数据库建库至2011年7月有关抗菌药物致TDP的病例报道，共16例，并进行分析。　结果　 16例患者中男3例，女13例；年龄17～88岁，平均54岁。6例患者存在心脏疾病；诱导TDP的抗菌药物包括常用的莫西沙星、司帕沙星、头孢拉定、头孢哌酮、磷霉素、克林霉素、两性霉素B、氟康唑、伊曲康唑以及不常用的红霉素、酮康唑；TDP发生时间为用药后（5.1±6.6） d，多数患者先出现心悸、心电图提示QTc间期延长，进而出现TDP。　结论　临床医师、药师应重视抗菌药物诱导TDP的不良反应。【Abstract】　Objective　 To investigate the regularity and characteristics of antimicrobial agents-induced torsade de pointes(TDP),and to provide reference for rational use of drugs.　Methods　 A total of 16 reported cases of antimicrobial agents-induced TDP were analyzed. 　Results　 The 16 cases including 3 males and 13 females at the age of 17-88 years with the mean age of 54. Six patients suffered from heart disease. The antimicrobial agents included moxifloxacin, sparfloxacin, cefradine, cefoperazone, fosfomycin, clindamycin, amphoterincin B, fluconazole, and itraconazole; which were used frequently, as well as some less frequently-used ones liked erythromycin, ketoconazole. The mean time from medication to onset of TDP was (5.1±6.6) days. Patients usually presented with palpitations at first following by prolonged QTc intervals, and then TDP appeared.　Conclusion　 Clinical physicians and pharmacists should pay attention to antimicrobial agents-induced TDP.

Citation： XIAO Guirong,WU Fengbo,TANG Yao. Antimicrobial Agents-induced Torsade De Pointes: Literature Analysis of 16 Cases. West China Medical Journal, 2011, 26(11): 1604-1607. doi: Copy

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2.	Rubinstein E, Camm J. Cardiotoxicity of fluoroquinolones[J]. J Antimicrob Chemother, 2002, 49(4): 593-596.
3.	关中宪, 方伟. 静滴红霉素诱发尖端扭转型室速1例[J]. 医学理论与实践, 1993, 6(6): 47.
4.	周智毅. 静脉内用红霉素与Q-T间期延长的潜在的致命性室速(尖端扭转型室速)有关[J]. 国外医学·内科学分册, 1991, 18(6): 285.
5.	安锐英, 韩学毅. 红霉素引起尖端扭转性室速[J]. 中国新药杂志, 1996, 5(3): 214-215.
6.	田婷婷, 张孝忠. 莫西沙星诱导尖端扭转型室速1例分析[J]. 中国误诊学杂志, 2010, 10(30): 7449.
7.	王琼, 蹇在金. 莫西沙星致高龄老年人尖端扭转型室性心动过速、室颤1例[J]. 中国临床保健杂志, 2009, 12(1): 76.
8.	张燕, 伍卫, 王景峰, 等. 司巴沙星致尖端扭转性室性心动过速、心室颤动一例[J]. 中华心血管病杂志, 2001, 29(10): 583.
9.	袁巩, 陶杰, 袁一琳, 等. 头孢环己烯致药物治性尖端扭转型室速一例[J]. 上海医学, 1997, (8): 496.
10.	俞良波, 向群, 姚强, 等. 头孢拉定引起恶性心律失常及致死各1例[J]. 新医学, 2006, 37(3): 191.
11.	严忠文, 胡识香, 赵克勤. 头孢哌酮致严重心律失常1例[J]. 医学导报, 2007, 26(10): 1248.
12.	董晓敏. 磷霉素致尖端扭转型室速1例[J]. 中国医院药学杂志, 2000, 20(9): 576-577.
13.	邓万俊. 克林霉素可能引起QT间期延长及心室纤颤[J]. 国外医药·抗生素手册, 1999, 20(6): 286-287.
14.	李瑞芬. 二性霉素B致尖端扭转型室速一例[J]. 中华传染病杂志, 1998, 16(4): 230.
15.	张凤香, 司忠义, 李树青, 等. 氟康唑致尖端扭转型室速1例[J]. 国际心血管病杂志, 2006, 33(5): 286.
16.	周庆平. 酮康唑诱发尖端扭转型室性心动过速1例[J]. 内科急危重症杂志, 1999, 5(1): 46.
17.	徐萍, 祝玉玲, 张继雁. 伊曲康唑致Q-T间期延长伴扭转型室性心动过速1例[J]. 新医学, 1999, 30(12): 716.
18.	Fitzgerald PT, ckerman MJ. Drug-induced torsades de pointes: the evolving role of pharmacogenetics[J]. Heart Rhythm, 2005, 2(2 Suppl): s30-s37.
19.	Mitcheson JS, Chen J, Lin M, et al. A structural basis for drug-indued long QT syndrome[J]. Proc Natl Acad Sci USA, 2000, 97(22): 12329-12333.
20.	De Bruin ML, Pettersson M, Meyboom RH, et al. Anti-HERG activity and the risk of drug-induced arrhythmias and sudden death[J]. Eur Heart J, 2005, 26(6): 590-597.
21.	Zelter D, Justo D, Haltin A, et al. Torsad de pointes due to noncardiac drugs: most patients have easily identifiable risk factors[J]. Medicine (Baltimore), 2003, 82(4): 282-290.

1. 　Shaffer D, Singer S, Korvick J, et al. Concomitant risk factors in reports of torsades depointes associated with macrolide use review of the United States Food and Drug Administration adverse event reporting system[J]. Clin Infect Dis, 2002, 35(2): 197-200.
2. 　Rubinstein E, Camm J. Cardiotoxicity of fluoroquinolones[J]. J Antimicrob Chemother, 2002, 49(4): 593-596.
3. 　关中宪, 方伟. 静滴红霉素诱发尖端扭转型室速1例[J]. 医学理论与实践, 1993, 6(6): 47.
4. 　周智毅. 静脉内用红霉素与Q-T间期延长的潜在的致命性室速(尖端扭转型室速)有关[J]. 国外医学·内科学分册, 1991, 18(6): 285.
5. 　安锐英, 韩学毅. 红霉素引起尖端扭转性室速[J]. 中国新药杂志, 1996, 5(3): 214-215.
6. 　田婷婷, 张孝忠. 莫西沙星诱导尖端扭转型室速1例分析[J]. 中国误诊学杂志, 2010, 10(30): 7449.
7. 　王琼, 蹇在金. 莫西沙星致高龄老年人尖端扭转型室性心动过速、室颤1例[J]. 中国临床保健杂志, 2009, 12(1): 76.
8. 　张燕, 伍卫, 王景峰, 等. 司巴沙星致尖端扭转性室性心动过速、心室颤动一例[J]. 中华心血管病杂志, 2001, 29(10): 583.
9. 　袁巩, 陶杰, 袁一琳, 等. 头孢环己烯致药物治性尖端扭转型室速一例[J]. 上海医学, 1997, (8): 496.
10. 　俞良波, 向群, 姚强, 等. 头孢拉定引起恶性心律失常及致死各1例[J]. 新医学, 2006, 37(3): 191.
11. 　严忠文, 胡识香, 赵克勤. 头孢哌酮致严重心律失常1例[J]. 医学导报, 2007, 26(10): 1248.
12. 　董晓敏. 磷霉素致尖端扭转型室速1例[J]. 中国医院药学杂志, 2000, 20(9): 576-577.
13. 　邓万俊. 克林霉素可能引起QT间期延长及心室纤颤[J]. 国外医药·抗生素手册, 1999, 20(6): 286-287.
14. 　李瑞芬. 二性霉素B致尖端扭转型室速一例[J]. 中华传染病杂志, 1998, 16(4): 230.
15. 　张凤香, 司忠义, 李树青, 等. 氟康唑致尖端扭转型室速1例[J]. 国际心血管病杂志, 2006, 33(5): 286.
16. 　周庆平. 酮康唑诱发尖端扭转型室性心动过速1例[J]. 内科急危重症杂志, 1999, 5(1): 46.
17. 　徐萍, 祝玉玲, 张继雁. 伊曲康唑致Q-T间期延长伴扭转型室性心动过速1例[J]. 新医学, 1999, 30(12): 716.
18. 　Fitzgerald PT, ckerman MJ. Drug-induced torsades de pointes: the evolving role of pharmacogenetics[J]. Heart Rhythm, 2005, 2(2 Suppl): s30-s37.
19. 　Mitcheson JS, Chen J, Lin M, et al. A structural basis for drug-indued long QT syndrome[J]. Proc Natl Acad Sci USA, 2000, 97(22): 12329-12333.
20. 　De Bruin ML, Pettersson M, Meyboom RH, et al. Anti-HERG activity and the risk of drug-induced arrhythmias and sudden death[J]. Eur Heart J, 2005, 26(6): 590-597.
21. 　Zelter D, Justo D, Haltin A, et al. Torsad de pointes due to noncardiac drugs: most patients have easily identifiable risk factors[J]. Medicine (Baltimore), 2003, 82(4): 282-290.

West China Medical Journal

Antimicrobial Agents-induced Torsade De Pointes: Literature Analysis of 16 Cases

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