Effect of ciprofloxacin and levofloxacin on the QT interval: is this a significant "clinical" event?

BACKGROUND

The widespread use of the fluoroquinolones has raised the question of the cardiac safety of these medications. This widespread use of this class of antibiotics has displayed their safety profile, which is actually more favorable than many other drug classes. The cardiac toxicity issue at the center of this discussion is the prolongation of the QT interval leading to torsade de pointes. Ciprofloxacin and levofloxacin, two of the more commonly used fluoroquinolones, are considered less likely than other fluoroquinolones to prolong the QT interval. The authors set out to evaluate the effect on the QT interval of patients after administration of ciprofloxacin and levofloxacin.

METHODS

A prospective evaluation of 38 consecutive patients evaluated by the infectious disease service and receiving either ciprofloxacin or levofloxacin was undertaken. Twelve-lead electrocardiograms were obtained at baseline and at least 48 hours after the first dose of the antibiotic was administered. Both the longest QT interval and the mean QT interval were evaluated. To account for variations in heart rate, the corrected QT interval was calculated by using Bazett's formula (QTc = QT(square root of) R-R). Statistical analysis was undertaken to assess for the presence of a change after the administration of the antibiotic.

RESULTS

Thirty-eight patients (mean age, 65 +/- 19 years), 23 women and 15 men, were studied. There was a small but significant increase in the longest QTc intervals over baseline in patients receiving levofloxacin; there was no significant change in the mean QTc interval. However, one patient who received levofloxacin was, statistically, an outlier and, on retrospective analysis, had demonstrated severe electrolyte disturbances at the time of the study. When this patient was excluded, the increase in the longest QTc interval was not significant. Patients receiving ciprofloxacin did not demonstrate any significant change in the longest QTc interval or mean QTc interval.

CONCLUSIONS

Neither levofloxacin nor ciprofloxacin significantly prolonged the mean QTc interval over baseline. When electrolyte deficiencies in one of the patients evaluated were taken into account, this also held true for the longest QTc interval. There is, therefore, evidence that taking ciprofloxacin or levofloxacin, assuming that there are not any concurrent risk factors, will not cause a significant prolongation in the QT interval.