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Rates of Torsades de Pointes Associated with Ciprofloxacin, Ofloxacin, Levofloxacin, Gatifloxacin, and Moxifloxacin
Author(s) -
Frothingham Richard
Publication year - 2001
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.21.20.1468.34482
Subject(s) - gatifloxacin , levofloxacin , moxifloxacin , ofloxacin , medicine , torsades de pointes , ciprofloxacin , qt interval , population , pharmacology , antibiotics , chemistry , environmental health , biochemistry
Study Objective. To compare the rates of torsades de pointes associated with ciprofloxacin, ofloxacin, levofloxacin, gatifloxacin, and moxifloxacin administration. Design. Retrospective database analysis. Intervention. Evaluation of reported rates of torsades de pointes in patients who received these quinolones between January 1, 1996, and May 2, 2001. Measurements and Main Results. In the United States, 25 cases of torsades de pointes associated with these quinolones (ciprofloxacin 2, ofloxacin 2, levofloxacin 13, gatifloxacin 8, moxifloxacin 0) were identified. Ciprofloxacin was associated with a significantly lower rate of torsades de pointes (0.3 cases/10 million prescriptions, 95% confidence interval [CI] 0.0–1.1) than levofloxacin (5.4/10 million, 95% CI 2.9–9.3, p<0.001) or gatifloxacin (27/10 million, 95% CI 12–53, p<0.001 for comparison with ciprofloxacin or levofloxacin). When the analysis was limited to the first 16 months after initial U.S. approval of the agent, the rates for levofloxacin (16/10 million) and gatifloxacin (27/10 million) were similar (p>0.5). Conclusion. Levofloxacin should be administered with caution in patients with risk factors for QT prolongation. Gatifloxacin should be avoided in the same patient population, and the recommended dosage of 400 mg/day should not be exceeded.