1981. Increased Cardiac Risk With Concomitant Levofloxacin (LVQ) and Amiodarone (AMIO) Therapy
Session: Poster Abstract Session: Antimicrobial Pharmacokinetics and Pharmacodynamics
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • LVN AMIO IDSA 10-2-16.pdf (1021.6 kB)
  • Background: LVQ and AMIO both prolong the QT interval. Case reports have highlighted the potential cardiac effects with concomitant use; however, no studies validating this concern have been completed in a real-world, clinical setting.

    Methods: A retrospective study of patients treated with LVQ and AMIO discharged from the medical center from January 1, 2012 to August 31, 2015 was performed. Inclusion was limited to patients ≥18 years of age. Patients on acute AMIO therapy immediately upon admission were excluded from the study. Patients were stratified into two groups: concomitant and non-concomitant usage of levofloxacin and amiodarone. The groups were further balanced using 2:1 propensity score matching based on age, gender, race, and Charlson comorbidity index. A secondary subset analysis was completed for patients with QT measurements before and after therapy initiation. The primary outcome was occurrence of cardiac events (ventricular arrhythmia, cardiac death) identified using validated ICD-9 codes and verified through patient chart review. The secondary outcome was change in adjusted QT interval (QTc) from baseline to post-treatment.

    Results: A total of 228 patients were included; 152 received concomitant LVQ and AMIO. Patients who received concomitant therapy were 6.6 times more likely to experience a cardiac event versus either LVQ or AMIO alone (15.1% versus 2.6%; OR=6.6, 95% confidence interval [CI] 1.74 – 42.3; p=0.004). All cause mortality was similar between concomitant vs the non-concomitant group (9.9% vs 9.2%, respectively; p=ns). The secondary analysis included 102 patients, 71 received concomitant LVQ and AMIO. There was a mean change from baseline in QTc interval of 30.54 milliseconds (ms) for the concomitant group and -0.50 ms for the non-concomitant group (mean difference, 31.03 ms; p<0.0001; 95% CI, 18.28 ms, 43.79 ms).

    Conclusion: A statistically significant increase in cardiac events and QTc interval prolongation was found in patients given concomitant LVQ and AMIO versus either medication alone.

    Benjamin Miao, PharmD Candidate1, Luigi Brunetti, PharmD, MPH1,2, John Bucek, MD3 and Ronald Nahass, MD, FIDSA, FSHEA4,5,6, (1)Pharmacy Practice and Administration, Rutgers, The State University of New Jersey, Piscataway, NJ, (2)Department of Pharmacy, Robert Wood Johnson University Hospital Somerset, Somerville, NJ, (3)Family Medicine, Robert Wood Johnson University Hospital Somerset, Somerville, NJ, (4)ID CARE, Hillsborough, NJ, (5)Medicine, Rutgers University - Robert Wood Johnson Medical School, New Brunswick, NJ, (6)Medicine, Robert Wood Johnson University Hospital, New Brunswick, NJ

    Disclosures:

    B. Miao, None

    L. Brunetti, None

    J. Bucek, None

    R. Nahass, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.