From the Research
Cefepime can potentially cause QTc prolongation, and healthcare providers should exercise caution when prescribing it to high-risk patients, such as those with pre-existing QT prolongation, electrolyte abnormalities, or underlying cardiac disease. According to the most recent study 1, drugs can cause long-QTc-syndrome, elevating the risk for palpitations, syncopes, and sudden cardiac death. The study highlights the importance of assessing additional risk factors, such as the intake of more than one QTc-prolongating drug and surgery, to determine the patient's perioperative risk.
When prescribing cefepime, it is essential to consider the patient's risk factors, including:
- Pre-existing QT prolongation
- Electrolyte abnormalities, particularly hypokalemia or hypomagnesemia
- Underlying cardiac disease
- Renal impairment, as cefepime is primarily eliminated by the kidneys and accumulation can increase the risk of adverse effects
- Concomitant use of other medications known to prolong the QT interval
ECG monitoring may be warranted in high-risk patients receiving cefepime, especially those with renal impairment. Dose adjustment is necessary in patients with renal dysfunction to minimize the risk of QTc prolongation. The mechanism behind cefepime-induced QTc prolongation likely involves interference with cardiac ion channels, particularly potassium channels responsible for cardiac repolarization. If QTc prolongation occurs during cefepime therapy, consider alternative antibiotics based on culture and sensitivity results, especially in patients with multiple risk factors for arrhythmias, as suggested by 2.
In clinical practice, the prevalence of significant QTc prolongation in patients receiving QT-prolonging medications is high, as reported by 3. Therefore, it is crucial to be aware of the potential risks and take preventive measures to minimize them. By considering the patient's individual risk factors and taking a cautious approach to prescribing cefepime, healthcare providers can help reduce the risk of QTc prolongation and its associated complications.