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    Bradycardia and Hypothermia Complicating Azithromycin Treatment.

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    Author
    Benn, K; Salman, S; Page-Sharp, M; Davis, TME; Buttery, JP
    Date
    2017-08-11
    Source Title
    The American journal of case reports
    Publisher
    International Scientific Information, Inc.
    University of Melbourne Author/s
    Buttery, Jim
    Affiliation
    Paediatrics (RCH)
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Benn, K., Salman, S., Page-Sharp, M., Davis, T. M. E. & Buttery, J. P. (2017). Bradycardia and Hypothermia Complicating Azithromycin Treatment.. Am J Case Rep, 18, pp.883-886. https://doi.org/10.12659/ajcr.905400.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/257128
    DOI
    10.12659/ajcr.905400
    Open Access at PMC
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5562267
    Abstract
    BACKGROUND Azithromycin is a macrolide antibiotic widely used to treat respiratory, urogenital, and other infections. Gastrointestinal upset, headache, and dizziness are common adverse effects, and prolongation of the rate-corrected electrocardiographic QT interval and malignant arrhythmias have been reported. There are rare reports of bradycardia and hypothermia but not in the same patient. CASE REPORT A 4-year-old boy given intravenous azithromycin as part of treatment for febrile neutropenia complicating leukemia chemotherapy developed hypothermia (rectal temperature 35.2°C) and bradycardia (65 beats/minute) after the second dose, which resolved over several days post-treatment, consistent with persistence of high tissue azithromycin concentrations relative to those in plasma. A sigmoid Emax pharmacokinetic/pharmacodynamic model suggested a maximal azithromycin-associated reduction in heart rate of 23 beats/minute. Monitoring for these potential adverse effects should facilitate appropriate supportive care in similar cases. CONCLUSIONS Recommended azithromycin doses can cause at least moderate bradycardia and hypothermia in vulnerable pediatric patients, adverse effects that should prompt appropriate monitoring and which may take many days to resolve.

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