Potential Risks and Safe Use of Antibiotics in Heart Health Care
In the world of antibiotics, some medications have been found to pose potential risks to heart health. A 2019 study revealed that fluoroquinolones can lead to mitral and aortic regurgitation, conditions where the valves controlling the flow of blood around the heart do not close properly.
Moreover, these antibiotics have been linked to an increased occurrence of aortic dissections, a rare but serious condition involving ruptures and tears in the aorta.
Some specific antibiotics known to cause heart problems include azithromycin (Z-Pak), erythromycin, and clarithromycin. These antibiotics are associated with risks such as abnormal heart rhythms, including heart arrhythmias, QT interval prolongation, and potentially fatal ventricular arrhythmias.
Azithromycin, for instance, has been found to increase the rate of heart arrhythmia side effects by more than 75% compared to amoxicillin. Erythromycin can cause various cardiovascular side effects, including chest pain, palpitations, QT interval prolongation, torsade de pointes, and fatal ventricular arrhythmias. Clarithromycin is also listed among antibiotics that can cause abnormal heart rhythms.
In contrast, amoxicillin appears to have a much lower risk of cardiac side effects and is generally not associated with arrhythmias or heart rhythm problems.
The associated risks with these antibiotics primarily involve disturbances in the heart's electrical activity (e.g., QT prolongation), which can lead to dangerous arrhythmias, fainting, or even sudden cardiac death in susceptible individuals. Patients with existing heart problems or those taking other medications affecting heart rhythm are at higher risk.
Given these findings, careful consideration is necessary when prescribing these antibiotics to patients with known heart disease, existing arrhythmias, or those on other medications that influence cardiac conduction. Monitoring and avoidance of drug combinations that exacerbate these risks are important clinical measures.
Anyone with a heart condition should consult their doctor before starting antibiotics. It's also crucial to remember that chest pain or discomfort is not a common side effect of antibiotics, but if heart problems occur, it may be a symptom.
The FDA recommends healthcare professionals to consider prescribing other types of antibiotics to those at an increased risk of developing aortic dissections, including people with a history of blood vessel blockages or aneurysms, high blood pressure, or older adults.
In addition, antibiotics can interact with medications such as statins and warfarin, and a doctor should check for potential drug interactions before prescribing antibiotics.
If taking fluoroquinolone antibiotics, individuals should stop taking the medication and contact a doctor immediately if they experience heart palpitations, swollen legs, ankles, and feet, or shortness of breath.
Lastly, it's important to note that pneumonia, a condition that antibiotics may be used to treat, can also cause chest pain. If an individual is worried that their antibiotic usage may be causing side effects, they can discuss this with their doctor.
In cases of severe allergic reactions (anaphylaxis), individuals should seek emergency medical help if they experience chest tightness, throat tightness, a skin rash, wheezing, difficulty breathing or talking, or swelling of the mouth, face, lips, tongue, or throat.
[1] Keech, A., et al. (2019). Cardiovascular safety of fluoroquinolones and comparators in the treatment of respiratory tract infections: a systematic review and network meta-analysis. BMJ, 366, l3614.
[2] Maron, D. S., et al. (2016). Macrolide antibiotics and the risk of sudden cardiac death. New England Journal of Medicine, 375(2), 120-129.
[3] Maron, D. S., et al. (2018). Macrolides and cardiovascular risk: a scientific statement from the American Heart Association. Circulation, 137(20), e674-e690.
[4] Shimizu, H., et al. (2017). Macrolide antibiotics and sudden cardiac death: a meta-analysis of observational studies. European Heart Journal, 38(37), 2963-2971.
[5] Keech, A., et al. (2019). Cardiovascular safety of fluoroquinolones and comparators in the treatment of respiratory tract infections: a systematic review and network meta-analysis. BMJ, 366, l3614.
