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  • Клиническое значение удлинения интервала QT на фоне применения антимикробных препаратов: анализ литературы и собственные наблюдения
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    Клиническое значение удлинения интервала QT на фоне применения антимикробных препаратов: анализ литературы и собственные наблюдения

    Яковлев С.В.
    ФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения РФ (Сеченовский Университет), Москва
    ,
    Юрина Юрина Е.А.
    ФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения РФ (Сеченовский Университет), Москва
    ,
    Козакевич Д.Р.
    ФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения РФ (Сеченовский Университет), Москва
    ,
    Суворова М.П.
    ФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения РФ (Сеченовский Университет), Москва
    DOI
    10.32756/0869-5490-2024-2-76-83
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    В научном сообществе до сих пор нет однозначной позиции относительно способности антимикробных препаратов удлинять интервал QT и вызывать жизнеугрожающие аритмии, прежде всего, желудочковую тахикардию типа пируэт (torsades de pointes). По данным литературы, самый высокий риск удлинения интервала QT наблюдается при применении макролидов (азитромицина, кларитромицина) и фторхинолонов (левофлоксацина, моксифлоксацина), среди антифунгальных препаратов – вориконазола и флуконазола. Риск возникновения аритмий повышался при комбинированном назначении этих препаратов. Факторами риска удлинения QT были сердечно-сосудистые заболевания, гипокалиемия, гипомагниемия, исходно удлиненный интервал QT, пожилой возраст и женский пол. Нами представлен клинический случай удлинения интервала QT и развития желудочковой тахикардии у пациента 32 лет на фоне терапии моксифлоксацином, а также 16 случаев удлинения интервала QT на фоне применения антимикробных препаратов (левофлоксацин, моксифлоксацин, азитромицин, флуконазол) с 2017 по 2022 гг. Развитие нарушений ритма, в том числе желудочковых аритмий, при удлинении интервала QT отмечено у 87,5% пациентов. Среднее удлинение интервала QT составило 127,0 мс у мужчин и 98,2 мс у женщин и наблюдалось в среднем через 4,4 и 5,4 дня после начала лечения, соответственно. При назначении антимикробных препаратов, удлиняющих интервал QT, следует предварительно оценить наличие факторов риска и сопутствующую терапию, а также мониторировать ЭКГ до и во время лечения. Возможно использование интернет-ресурса для оценки риска развития удлинения QT и желудочковых аритмий.

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