zithromax and Heart-Diseases

We report a series of 28 consecutive patients with erythema migrans (EM) who underwent skin biopsies for culture of Borrelia burgdorferi. Culture results, Lyme serologic findings, and clinical features in patients with only primary EM are compared with those in patients with secondary EM.. Culture preparations of skin specimens obtained from six of 12 patients with only primary EM, and from 14 of 16 patients with secondary EM were positive for B burgdorferi. Seven patients with only primary EM were initially seronegative, and only one patient had an annular lesion. A central crusted punctum was present in five of six primary EM lesions that were not culture positive, but in none of nine culture-positive primary EM lesions. Patients with secondary EM were all seropositive and had less cutaneous and more constitutional symptoms than patients with only primary EM. Three patients with secondary EM had abnormal liver enzyme profiles, one patient had complete heart block, and one patient had myocarditis simulating infarction. Less than one third of all patients recalled a tick bite. An isomorphic nonresponse was seen in skin previously involved with secondary EM in one patient who had a drug exanthem from amoxicillin.. Borrelia burgdorferi can be reliably cultured from skin biopsy specimens of secondary EM. Culture preparation aids definitive diagnosis of Lyme disease in patients with only primary EM who often lack constitutional symptoms, have nondiagnostic lesions, or are seronegative.

Topics: Administration, Oral; Adult; Amoxicillin; Antibodies, Bacterial; Azithromycin; Borrelia burgdorferi Group; Erythema Chronicum Migrans; Erythromycin; Female; Heart Diseases; Humans; Male; Middle Aged; Recurrence; Skin; Wisconsin

Chloroquine or hydroxychloroquine (chloroquine) plus azithromycin is considered as therapy for COVID-19. With benefit evaluations underway, safety concerns due to potential additive effects on QTc prolongation should be addressed.. We compared risk of cardiac adverse events between combinations of chloroquine and azithromycin and chloroquine and amoxicillin.. We conducted a retrospective cohort study using the IBM MarketScan Commercial Claims and Medicare Supplemental Databases, 2005-2018. We included autoimmune disease patients aged ≥18 years initiating azithromycin or amoxicillin for ≥5 days during chloroquine treatment. Patients had continuous insurance coverage ≥6 months before combination use until 5 days thereafter or inpatient death. Two outcomes were sudden cardiac arrest/ventricular arrhythmias (SCA/VA) and cardiac symptoms. We followed patients for up to 5 days to estimate hazard ratios (HR). Covariates were adjusted using stabilized inverse probability treatment weighting.. We identified two SVC/VA events among >145,000 combination users. The adjusted incidence of cardiac symptoms among azithromycin and amoxicillin users was 276 vs 254 per 10,000 person-years with an adjusted HR of 1.10 (95%CI, 0.62-1.95).. Combination use of chloroquine and azithromycin at routine doses did not show pronounced increases in arrhythmias in this real-world population, though small sample size and outcome rates limit conclusions.

Topics: Adolescent; Adult; Aged; Azithromycin; Chloroquine; Cohort Studies; COVID-19; COVID-19 Drug Treatment; Drug Therapy, Combination; Female; Heart Diseases; Humans; Hydroxychloroquine; Male; Middle Aged; Pharmacoepidemiology; Retrospective Studies; Risk Factors; Young Adult

Topics: Azithromycin; Cardiotoxicity; COVID-19; COVID-19 Drug Treatment; Databases, Factual; Electrocardiography; Heart Diseases; Humans; Hydroxychloroquine; Pharmacovigilance; Public Health Surveillance; World Health Organization

Invasive mechanical has been associated with high mortality in COVID-19. Alternative therapy of high flow nasal therapy (HFNT) has been greatly debated around the world for use in COVID-19 pandemic due to concern for increased healthcare worker transmission.This was a retrospective analysis of consecutive patients admitted to Temple University Hospital in Philadelphia, Pennsylvania, from 10 March 2020 to 24 April 2020 with moderate-to-severe respiratory failure treated with HFNT. Primary outcome was prevention of intubation. Of the 445 patients with COVID-19, 104 met our inclusion criteria. The average age was 60.66 (+13.50) years, 49 (47.12 %) were female, 53 (50.96%) were African-American, 23 (22.12%) Hispanic. Forty-three patients (43.43%) were smokers. Saturation to fraction ratio and chest X-ray scores had a statistically significant improvement from day 1 to day 7. 67 of 104 (64.42%) were able to avoid invasive mechanical ventilation in our cohort. Incidence of hospital-associated/ventilator-associated pneumonia was 2.9%. Overall, mortality was 14.44% (n=15) in our cohort with 13 (34.4%) in the progressed to intubation group and 2 (2.9%) in the non-intubation group. Mortality and incidence of pneumonia was statistically higher in the progressed to intubation group. CONCLUSION: HFNT use is associated with a reduction in the rate of invasive mechanical ventilation and overall mortality in patients with COVID-19 infection.

Topics: Adrenal Cortex Hormones; Aged; Anti-Bacterial Agents; Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Azithromycin; Betacoronavirus; Black or African American; Cannula; Comorbidity; Coronavirus Infections; COVID-19; Diabetes Mellitus; Female; Healthcare-Associated Pneumonia; Heart Diseases; Hispanic or Latino; Humans; Hydroxychloroquine; Hypertension; Hypoxia; Immunoglobulins, Intravenous; Immunologic Factors; Intubation, Intratracheal; Lung Diseases; Male; Middle Aged; Oxygen Inhalation Therapy; Pandemics; Philadelphia; Pneumonia, Ventilator-Associated; Pneumonia, Viral; Pulse Therapy, Drug; Renal Insufficiency, Chronic; Respiratory Insufficiency; Retrospective Studies; SARS-CoV-2; Severity of Illness Index; Smoking; White People

As is well-known, hERG plays an essential role in phase III repolarization of cardiac action potentials. Blocking of hERG channels can lead to LQTS. Inhibition of the metabolism of CYPs activities may elevate plasma levels, to further increase accumulation of drug on cardiac. The elevated serum levels may however elicit unexpected toxicities. Therefore, the inhibition tests of hERG and CYP are central to the preclinical studies because they may lead to severe cardiac toxicity. Berberine is widely used as an antibacterial agent and often combined with macrolides to treat gastropathy. Our objective was to assess cardiac toxicity during the combined use of Berberine with macrolides. (1) Azithromycin reduced hERG currents by accelerated channel inactivation. (2) The combination of Berberine with Azithromycin reduced hERG currents, producing an inhibitive effect stronger than use of a single drug alone, due to the high binding affinity for the onset of inactivation. (3) When cells were perfused concomitantly with Berberine and Clarithromycin, they showed a stronger inhibitive effect on hERG currents by decreasing the time constant for the onset of inactivation. (4) The combined administration of Berberine with Clarithromycin had a powerful inhibitive effect on CYP3A activities than use of a single drug alone. Collectively, these results demonstrated that concomitant use of Berberine with macrolides may require close monitoring because of potential drug toxicities, especially cardiac toxicity.

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Berberine; Clarithromycin; Cytochrome P-450 CYP3A; Cytochrome P-450 CYP3A Inhibitors; Drug Synergism; ERG1 Potassium Channel; Ether-A-Go-Go Potassium Channels; Heart Diseases; HEK293 Cells; Humans; Male; Membrane Potentials; Microsomes, Liver; Myocytes, Cardiac; Potassium Channel Blockers; Rats; Rats, Wistar; Risk Assessment; Transfection

An 8-month-old infant with cyanotic heart disease and transfusion-associated Babesia microti infection is reported here. At initial presentation, she was ill appearing, febrile and cyanotic. Laboratory tests revealed severe anemia, thrombocytopenia and an increase in hepatic enzymes. The diagnosis was made by the presence of intraerythrocytic parasites on thin blood smear and confirmed by serology and polymerase chain reaction. The infant was treated successfully with a combination of oral azithromycin and atovaquone. This combination is an alternative to clindamycin and quinine for the treatment of children with babesiosis.

Topics: Animals; Antigens, Protozoan; Antiprotozoal Agents; Atovaquone; Azithromycin; Babesia microti; Babesiosis; Blood Transfusion; Cyanosis; DNA, Protozoan; Erythrocytes; Female; Fluorescent Antibody Technique, Direct; Heart Diseases; Humans; Infant; Polymerase Chain Reaction