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：

抗菌藥物; 尖端扭轉型室速; 不良反應

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【摘要】　目的　探討抗菌藥物誘導尖端扭轉型室速（torsade de pointes，TDP）的規律及特點，為臨床合理用藥提供參考。　方法　檢索中國期刊全文數據庫、維普、萬方、中國生物醫學文獻數據庫建庫至2011年7月有關抗菌藥物致TDP的病例報道，共16例，并進行分析。　結果　 16例患者中男3例，女13例；年齡17～88歲，平均54歲。6例患者存在心臟疾病；誘導TDP的抗菌藥物包括常用的莫西沙星、司帕沙星、頭孢拉定、頭孢哌酮、磷霉素、克林霉素、兩性霉素B、氟康唑、伊曲康唑以及不常用的紅霉素、酮康唑；TDP發生時間為用藥后（5.1±6.6） d，多數患者先出現心悸、心電圖提示QTc間期延長，進而出現TDP。　結論　臨床醫師、藥師應重視抗菌藥物誘導TDP的不良反應。【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

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.	關中憲, 方偉. 靜滴紅霉素誘發尖端扭轉型室速1例[J]. 醫學理論與實踐, 1993, 6(6): 47.
4.	周智毅. 靜脈內用紅霉素與Q-T間期延長的潛在的致命性室速(尖端扭轉型室速)有關[J]. 國外醫學·內科學分冊, 1991, 18(6): 285.
5.	安銳英, 韓學毅. 紅霉素引起尖端扭轉性室速[J]. 中國新藥雜志, 1996, 5(3): 214-215.
6.	田婷婷, 張孝忠. 莫西沙星誘導尖端扭轉型室速1例分析[J]. 中國誤診學雜志, 2010, 10(30): 7449.
7.	王瓊, 蹇在金. 莫西沙星致高齡老年人尖端扭轉型室性心動過速、室顫1例[J]. 中國臨床保健雜志, 2009, 12(1): 76.
8.	張燕, 伍衛, 王景峰, 等. 司巴沙星致尖端扭轉性室性心動過速、心室顫動一例[J]. 中華心血管病雜志, 2001, 29(10): 583.
9.	袁鞏, 陶杰, 袁一琳, 等. 頭孢環己烯致藥物治性尖端扭轉型室速一例[J]. 上海醫學, 1997, (8): 496.
10.	俞良波, 向群, 姚強, 等. 頭孢拉定引起惡性心律失常及致死各1例[J]. 新醫學, 2006, 37(3): 191.
11.	嚴忠文, 胡識香, 趙克勤. 頭孢哌酮致嚴重心律失常1例[J]. 醫學導報, 2007, 26(10): 1248.
12.	董曉敏. 磷霉素致尖端扭轉型室速1例[J]. 中國醫院藥學雜志, 2000, 20(9): 576-577.
13.	鄧萬俊. 克林霉素可能引起QT間期延長及心室纖顫[J]. 國外醫藥·抗生素手冊, 1999, 20(6): 286-287.
14.	李瑞芬. 二性霉素B致尖端扭轉型室速一例[J]. 中華傳染病雜志, 1998, 16(4): 230.
15.	張鳳香, 司忠義, 李樹青, 等. 氟康唑致尖端扭轉型室速1例[J]. 國際心血管病雜志, 2006, 33(5): 286.
16.	周慶平. 酮康唑誘發尖端扭轉型室性心動過速1例[J]. 內科急危重癥雜志, 1999, 5(1): 46.
17.	徐萍, 祝玉玲, 張繼雁. 伊曲康唑致Q-T間期延長伴扭轉型室性心動過速1例[J]. 新醫學, 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. 　關中憲, 方偉. 靜滴紅霉素誘發尖端扭轉型室速1例[J]. 醫學理論與實踐, 1993, 6(6): 47.
4. 　周智毅. 靜脈內用紅霉素與Q-T間期延長的潛在的致命性室速(尖端扭轉型室速)有關[J]. 國外醫學·內科學分冊, 1991, 18(6): 285.
5. 　安銳英, 韓學毅. 紅霉素引起尖端扭轉性室速[J]. 中國新藥雜志, 1996, 5(3): 214-215.
6. 　田婷婷, 張孝忠. 莫西沙星誘導尖端扭轉型室速1例分析[J]. 中國誤診學雜志, 2010, 10(30): 7449.
7. 　王瓊, 蹇在金. 莫西沙星致高齡老年人尖端扭轉型室性心動過速、室顫1例[J]. 中國臨床保健雜志, 2009, 12(1): 76.
8. 　張燕, 伍衛, 王景峰, 等. 司巴沙星致尖端扭轉性室性心動過速、心室顫動一例[J]. 中華心血管病雜志, 2001, 29(10): 583.
9. 　袁鞏, 陶杰, 袁一琳, 等. 頭孢環己烯致藥物治性尖端扭轉型室速一例[J]. 上海醫學, 1997, (8): 496.
10. 　俞良波, 向群, 姚強, 等. 頭孢拉定引起惡性心律失常及致死各1例[J]. 新醫學, 2006, 37(3): 191.
11. 　嚴忠文, 胡識香, 趙克勤. 頭孢哌酮致嚴重心律失常1例[J]. 醫學導報, 2007, 26(10): 1248.
12. 　董曉敏. 磷霉素致尖端扭轉型室速1例[J]. 中國醫院藥學雜志, 2000, 20(9): 576-577.
13. 　鄧萬俊. 克林霉素可能引起QT間期延長及心室纖顫[J]. 國外醫藥·抗生素手冊, 1999, 20(6): 286-287.
14. 　李瑞芬. 二性霉素B致尖端扭轉型室速一例[J]. 中華傳染病雜志, 1998, 16(4): 230.
15. 　張鳳香, 司忠義, 李樹青, 等. 氟康唑致尖端扭轉型室速1例[J]. 國際心血管病雜志, 2006, 33(5): 286.
16. 　周慶平. 酮康唑誘發尖端扭轉型室性心動過速1例[J]. 內科急危重癥雜志, 1999, 5(1): 46.
17. 　徐萍, 祝玉玲, 張繼雁. 伊曲康唑致Q-T間期延長伴扭轉型室性心動過速1例[J]. 新醫學, 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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