Can hydroxychloroquine and azithromycin combination cause cardiac rhythm disturbances in children with COVID-19 pneumonia?

Year 2025, Volume: 8 Issue: 2, 308 - 312, 21.03.2025

Damla Geçkalan , Rahmi Özdemir , Yasin Yılmaz Cemile Hilal Çelik Batuhan Berk Demir , Yeşim Tunç

https://doi.org/10.32322/jhsm.1625339

Abstract

Aims: At the beginning of the COVID-19 pandemic; it has been shown that receiving hydroxychloroquine and azithromycin treatment decrease viral carriage of coronavirus in patients. In this study, we aimed to evaluate electrocardiography (ECG) abnormalities in pediatric patients with COVID-19 pneumonia receiving combined therapy with hydroxychloroquine and azithromycin.
Methods: In this study; ECG and laboratory parameters of 24 children with COVID-19 pneumonia who were treated with hydroxychloroquine and azithromycin at Health Sciences University between June 2020 and November 2020 were analyzed retrospectively. P wave dispersion (PWd), QT interval (QT), QT dispersion (QTd), QTc interval (QTc), QTc dispersion (QTcd), Tpeak-Tend interval (Tp-e), Tp-e dispersion (Tp-ed), Tp-e/QT, Tp-Te/QTc ratios were evaluated with 12 lead ECG. ECG parameters and QTc interval were compared before and after (5 days) the treatment.
Results: The mean age was 13±4.5 years and 62.5% were female. Median hospitalization length was 6 days. There was no statistically significant difference between the PWd, QT and QTc interval, QTd, QTcd, Tp-e interval, Tp-e dispersion, Tp-e/QT, Tp-e/QTd measurements and ratios of the before and after treatment. A significant difference was found for the decrease in hearth rate in regard to the measurement before and after the treatment.
Conclusion: In our study, there were no rhythm problems which were observed on ECG in pediatric patients receiving hydroxychloroquine and azithromycin combination therapy for COVID-19 pneumonia. We also found that laboratory parameters were not specific for COVID-19 pneumonia in children.

Keywords

Azithromycin, COVID-19, D-dimer, hydroxychloroquine, side effects, QTc prolongation

COVID-19 pnömonisi olan çocuklarda Hidroksiklorokin ve azitromisin beraber kullanımı kardiyak ritim bozukluklarına neden olur mu?

Abstract

Giriş
COVID-19 pandemisinin başlangıcında; hidroksiklorokin ve azitromisin tedavisi almanın hastalarda koronavirüs viral taşıyıcılığını azalttığı gösterilmiştir. Bu çalışmada, hidroksiklorokin ve azitromisin ile kombine tedavi alan COVID-19 pnömonili çocuk hastalarda elektrokardiyografi [EKG] anormalliklerini değerlendirmeyi amaçladık.
Yöntemler
Bu çalışmada; Haziran 2020 - Kasım 2020 tarihleri arasında Sağlık Bilimleri Üniversitesi'nde hidroksiklorokin ve azitromisin ile tedavi edilen COVID-19 pnömonili 24 çocuğun EKG ve laboratuvar parametreleri retrospektif olarak analiz edilmiştir. P dalgası dispersiyonu [PWd], QT aralığı [QT], QT dispersiyonu [QTd], QTc aralığı [QTc], QTc dispersiyonu [QTcd], Tpeak-Tend aralığı [Tp-e], Tp-e dispersiyonu [Tp-ed], Tp-e/QT, Tp-Te/QTc oranları 12 derivasyonlu EKG ile değerlendirildi. EKG parametreleri ve QTc aralığı tedaviden önce ve sonra [5 gün] karşılaştırıldı.
Sonuç
Ortalama yaş 13 ± 4,5 yıldı ve %62,5'i kızdı. Medyan hastanede yatış süresi 6 gündü. Tedavi öncesi ve sonrası PWd, QT ve QTc intervali, QTd, QTcd, Tp-e intervali, Tp-e dispersiyonu, Tp-e/QT, Tp-e/QTd ölçümleri ve oranları arasında istatistiksel olarak anlamlı bir fark yoktu [p>0.05]. Tedavi öncesi ve sonrasında sadece kalp hızındaki azalma istatistiksel olarak anlamlı bulunmuştur [p<0.05].
Tartışma
Hidroksiklorokin ve azitromisin kombine tedavisinin erişkin hastalarda en korkulan yan etkileri QTc uzaması ve ventriküler aritmidir. Çalışmamızda, COVID-19 pnömonisi için hidroksiklorokin ve azitromisin kombinasyon tedavisi alan çocuk hastalarda EKG'de herhangi bir ritim sorunu gözlenmemiştir. Çocuklarda çok az kullanımı olan bu ilaçlar ile daha geniş hasta sayısı olan çalışmalara ihtiyaç vardır.

Keywords

Azitromisin, COVID-19, D-dimer, Hidroksiklorokin, Yan etkiler, QTc uzaması

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