Paroxysmal Atrial Fibrillation Induced by Ciprofloxacin: A Rare Adverse Effect

  • Fatma Hammami Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
  • Makram Koubaa Mail Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
  • Sahar Ben Kahla Cardiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
  • Amal Chakroun Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
  • Khaoula Rekik Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
  • Fatma Smaoui Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
  • Mounir Ben Jemaa Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
Keywords:
Ciprofloxacin, Atrial Fibrillation, Drug-Related Side Effects;, Arrhythmias

Abstract

Despite their adverse effects, fluoroquinolones continue to be commonly prescribed antibiotics. Ciprofloxacin remains the safest with remarkably few adverse effects of all fluoroquinolones. Here, we present a rare case of paroxysmal atrial fibrillation induced by ciprofloxacin intake in a 72-year-old woman. She was treated with ciprofloxacin and ceftriaxone for urinary tract infection caused by Klebsiella pneumonia and complicated with liver abscess. On the fifth day of ciprofloxacin intake, she suddenly complained of heart palpitations and epigastric pain. An electrocardiogram revealed supraventricular tachycardia type atrial fibrillation at 130 beats per minute. No QT interval prolongation was noted. Ciprofloxacin was stopped as it was the most incriminated to induce arrhythmia. A control electrocardiogram showed normal sinus rhythm. We continued ceftriaxone use solely for 3 weeks until the resolution of the liver abscess. Although rare, early detection of atrial fibrillation induced by ciprofloxacin may decrease the severity of complications and prevent death.

References

1. Yu X, Jiang D sheng, Wang J, et al. Fluoroquinolone Use and the Risk of Collagen-Associated Adverse Events: A Systematic Review and Meta-Analysis. Drug Saf 2019;42(9):1025-33.
2. Cho Y, Park HS. Association of oral ciprofloxacin, levofloxacin, ofloxacin and moxifloxacin with the risk of serious ventricular arrhythmia: A nationwide cohort study in Korea. BMJ Open 2018;8(9):e020974.
3. Gorelik E, Masarwa R, Perlman A, et al. Fluoroquinolones and Cardiovascular Risk: A Systematic Review, Meta-analysis and Network Meta-analysis. Drug Saf 2019;42(4):529-38.
4. Berger FA, Monadian N, de Groot NMS, et al. QTc prolongation during ciprofloxacin and fluconazole combination therapy: prevalence and associated risk factors. Br J Clin Pharmacol 2018;84(2):369-78.
5. Liu X, Ma J, Huang L, et al. Fluoroquinolones increase the risk of serious arrhythmias: A systematic review and meta-analysis. Medicine 2017;96(44):e8273.
6. Porta L, Lee MG, Hsu W, Hsu T, Tsai T, Lee C. Fluoroquinolone use and serious arrhythmias : A nationwide case-crossover study. Resuscitation 2019;139:262-8.
7. Clark DWJ, Layton D, Wilton LV, Pearce GL, Shakir SAW. Profiles of hepatic and dysrhythmic cardiovascular events following use of fluoroquinolone antibacterials: Experience from large cohorts from the drug safety research unit prescription-event monitoring database. Drug Saf 2001;24(15):1143-54.
8. Sideri G, Kafetzis DA, Vouloumanou EK, Papadatos JH, Papadimitriou M, Falagas ME. Ciprofloxacin in critically ill children. Anaesth Intensive Care 2011;39(4):635-9.
9. M Bolognesi, D Bolognesi. Ciprofloxacin-induced paroxysmal atrial fibrillation.OA Case Reports 2014;3(3):24.
10. Depoorter L, Sels L, Deschodt M, Van Grootven B, Van der Linden L, Tournoy J. Clinical Outcomes of Rate vs Rhythm Control for Atrial Fibrillation in Older People: A Systematic Review and Meta-Analysis. Drugs Aging 2020;37(1):19-26.
11. McCallum CJ, Raja DC, Pathak RK. Atrial fibrillation: An update on management. Aust Prescr 2019;42(6):186-91.
12. Niedrig D, Maechler S, Hoppe L, Corti N, Kovari H, Russmann S. Drug safety of macrolide and quinolone antibiotics in a tertiary care hospital: administration of interacting co-medication and QT prolongation. Eur J Clin Pharmacol 2016;72(7):859-67.
13. Achkasov E, Bondarev S, Smirnov V, et al. Atrial fibrillation in athletes-features of development, current approaches to the treatment, and prevention of complications. Int J Environ Res Public Health 2019;16(24):e4890.
14. Cornett E, Novitch MB, Kaye AD, et al. Macrolide and fluoroquinolone mediated cardiac arrhythmias: clinical considerations and comprehensive review. Postgrad Med 2017;129(7):715-24.
Published
2020-06-26
How to Cite
1.
Hammami F, Koubaa M, Ben Kahla S, Chakroun A, Rekik K, Smaoui F, Ben Jemaa M. Paroxysmal Atrial Fibrillation Induced by Ciprofloxacin: A Rare Adverse Effect. J Pharm Care. 8(2):90-92.
Section
Case Report(s)