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Pharmacy 2017, 5(4), 61; doi:10.3390/pharmacy5040061

Assessment of Prescribing and Monitoring Habits for Patients Taking an Antiarrhythmic and Concomitant QTc-Prolonging Antibiotic

Einstein Medical Center-Philadelphia, 5501 Old York Road, Philadelphia, PA 19141, USA
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Received: 26 September 2017 / Revised: 21 October 2017 / Accepted: 30 October 2017 / Published: 1 November 2017
(This article belongs to the Special Issue Communication in Pharmacy Practice)
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Abstract

Patients may intermittently require antimicrobial therapy with a QTc-prolonging antibiotic, which presents a challenge for prescribers of patients already taking a QTc-prolonging antiarrhythmic. Manufacturers recommend close monitoring for evidence of QTc-prolongation with the concomitant use of QTc-prolonging medications, but the monitoring parameters are not well-defined. Previous studies recommend a surveillance electrocardiogram (EKG) be completed both before and after the initiation of QTc-prolonging medications, but it is unknown to what degree EKGs displaying the QTc-interval are used to alter physician order entry and pharmacist order verification during concomitant therapy. A retrospective chart review was conducted between October 2015–September 2016 to assess prescribing and monitoring habits for patients taking an antiarrhythmic and a concomitant QTc-prolonging antibiotic. Of the 42 patients who received at least one dose of two QTc-prolonging agents, 36 (85.7%) received a baseline EKG, and 23 (63.8%) received a follow-up EKG. Pharmacists intervened on this drug–drug interaction and recommended follow-up EKGs only three times (8.3%) and offered alternative therapy recommendations once (2.8%). The QTc-interval was not optimally monitored in some instances for patients concomitantly receiving two QTc-prolonging agents. These results stress the importance of inter-professional communication to place an emphasis on follow-up monitoring or use of alternative therapy agents to avoid the drug–drug interaction altogether. View Full-Text
Keywords: QTc-prolongation; electrocardiogram; antiarrhythmic; macrolide; fluoroquinolone; drug-interaction QTc-prolongation; electrocardiogram; antiarrhythmic; macrolide; fluoroquinolone; drug-interaction
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Noss, K.; Aguero, S.M.; Reinaker, T. Assessment of Prescribing and Monitoring Habits for Patients Taking an Antiarrhythmic and Concomitant QTc-Prolonging Antibiotic. Pharmacy 2017, 5, 61.

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