zithromax and Febrile-Neutropenia

Topics: Adult; Azithromycin; Cefepime; COVID-19; COVID-19 Drug Treatment; Febrile Neutropenia; Female; Humans; Hydroxychloroquine; Immunocompromised Host; Kidney Transplantation; SARS-CoV-2; Transplant Recipients

The COVID-19 pandemic has dramatically challenged care for cancer patients, especially those with active treatment who represent a vulnerable population for SARS-CoV-2 infection. Aggressive lymphoid neoplasms, such as diffuse large B cell lymphoma and high-grade B cell lymphoma, need to be treated without delay in order to get the best disease outcome. Because of that, our clinical practice was changed to minimise the risk of SARS-CoV-2 infection while continuing haematological treatment. In this report, we analyse the management of front-line therapy in 18 patients during the COVID-19 outbreak, as well as the results of the implemented measures in their outcome.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Azithromycin; Bacterial Infections; COVID-19; COVID-19 Drug Treatment; COVID-19 Testing; Cyclophosphamide; Doxorubicin; Febrile Neutropenia; Female; Granulocyte Colony-Stimulating Factor; Humans; Hydroxychloroquine; Infection Control; Lymphoma, Large B-Cell, Diffuse; Male; Middle Aged; Pandemics; Plasmablastic Lymphoma; Prednisone; Rituximab; SARS-CoV-2; Spain; Superinfection; Vincristine

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.

Topics: Anti-Bacterial Agents; Azithromycin; Bradycardia; Child, Preschool; Febrile Neutropenia; Humans; Hypothermia; Leukemia; Male