ro13-9904 and Arrhythmias--Cardiac

The combination of ceftriaxone and lansoprazole has been shown to prolong the corrected QT interval on electrocardiogram. However, it is unknown whether this translates to clinically important patient outcomes.. To compare lansoprazole with another proton pump inhibitor (PPI) during ceftriaxone treatment in terms of risk for ventricular arrhythmia, cardiac arrest, and in-hospital mortality.. A retrospective cohort study including adult medical inpatients receiving ceftriaxone with lansoprazole or another PPI in 13 hospitals in Ontario, Canada, was conducted from January 1, 2015, to December 31, 2021.. Lansoprazole during ceftriaxone treatment vs other PPIs during ceftriaxone treatment.. The primary outcome was a composite of ventricular arrhythmia or cardiac arrest that occurred after hospital admission. The secondary outcome was all-cause in-hospital mortality. Propensity-score weighting was used to adjust for covariates including hospital site, demographic characteristics, comorbidities, risk factors for ventricular arrhythmia, illness severity, admitting diagnoses, and concomitant medications.. Of the 31 152 patients hospitalized on internal medicine wards who were treated with ceftriaxone while receiving a PPI, 16 135 patients (51.8%) were male, and the mean (SD) age was 71.7 (16.0) years. The study included 3747 patients in the lansoprazole group and 27 405 patients in the other PPI group. Ventricular arrhythmia or cardiac arrest occurred in 126 patients (3.4%) within the lansoprazole group and 319 patients (1.2%) within the other PPI group. In-hospital mortality occurred in 746 patients (19.9%) within the lansoprazole group and 2762 patients (10.1%) in the other PPI group. After weighting using propensity scores, the adjusted risk difference for the lansoprazole group minus other PPI group was 1.7% (95% CI, 1.1%-2.3%) for ventricular arrhythmia or cardiac arrest and 7.4% (95% CI, 6.1%-8.8%) for in-hospital mortality.. The findings of this cohort study suggest that combination therapy with lansoprazole and ceftriaxone should be avoided. More studies are needed to determine whether these findings could be replicated in other populations and settings.

Topics: Adult; Aged; Arrhythmias, Cardiac; Ceftriaxone; Cohort Studies; Female; Heart Arrest; Humans; Inpatients; Lansoprazole; Male; Ontario; Proton Pump Inhibitors; Retrospective Studies

Recent results from data mining analyses and reports of adverse drug events suggest a QT-prolonging drug-drug interaction resulting from the combination of distinct proton pump inhibitors and cephalosporins. Therefore, this study aimed at investigating the effect of the suspected QT-prolonging combinations of lansoprazole + ceftriaxone and esomeprazole + cefazolin, respectively. 26 hearts of New Zealand White rabbits were retrogradely perfused and paced at different cycle lengths. After generating baseline data, the hearts were assigned to two groups: In group 1, hearts were treated with 5 µM lansoprazole. Thereafter, 200 µM ceftriaxone was infused additionally. Group 2 was perfused with 10 µM esomeprazole followed by 250 µM cefazolin. In group 1, lansoprazole did not significantly alter QT intervals and APD

Topics: Action Potentials; Animals; Anti-Bacterial Agents; Arrhythmias, Cardiac; Cardiac Pacing, Artificial; Ceftriaxone; Drug Interactions; Esomeprazole; Female; Heart Conduction System; Heart Rate; Isolated Heart Preparation; Lansoprazole; Proton Pump Inhibitors; Rabbits; Refractory Period, Electrophysiological; Risk Assessment; Time Factors

Topics: Adolescent; Anti-Bacterial Agents; Arrhythmias, Cardiac; Ceftriaxone; Child; Child, Preschool; Female; Heart Block; Hospitals, Pediatric; Humans; Leptospirosis; Male; Osteomyelitis; Shock, Septic; Singapore; Tertiary Care Centers

Borreliosis is a multisystemic disease transmitted by ticks. Its diagnosis still remains a challenge because of the varied clinical picture and of difficulties in detection of the etiological agent (Borrelia burgdorferi). We report a case of a 53-years-old woman admitted to the Clinic of Cardiology due to life-threatening arhythmias with simultaneous deficits in concentration and memory. A suspicion of borreliosis was driven from the presence of cardiac symptoms as well as of psychiatric and from the case histories of a tick bite. The diagnosis was confirmed both by specific serological test and endomyocardial biopsy which revealed spirochetes. The patient responded to treatment with doxycyclin and ceftriaxone. Cardiologic disorders retreated entirely, while cognitive deficits did only partly.

Topics: Arrhythmias, Cardiac; Biopsy; Borrelia burgdorferi; Ceftriaxone; Doxycycline; Drug Therapy, Combination; Female; Heart; Humans; Lyme Disease; Memory Disorders; Mental Disorders; Middle Aged; Myocarditis; Myocardium; Serologic Tests

Topics: Adult; Arrhythmias, Cardiac; Arthritis, Infectious; Ceftriaxone; Child; Doxycycline; Female; Humans; Lyme Disease; Male; Microbial Sensitivity Tests; Nervous System Diseases; Penicillins; Pregnancy; Tetracycline