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

Geçkalan et al., Journal of Health Sciences and Medicine, doi:10.32322/jhsm.1625339, Mar 2025
HCQ for COVID-19
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Retrospective 24 pediatric COVID-19 pneumonia patients showing no cardiac rhythm disturbances or QTc prolongation with hydroxychloroquine and azithromycin combination therapy.
Geçkalan et al., 21 Mar 2025, retrospective, China, peer-reviewed, mean age 13.0, 6 authors, study period June 2020 - November 2020. Contact: drdamlageckalan@gmail.com.
Can hydroxychloroquine and azithromycin combination cause cardiac rhythm disturbances in children with COVID-19 pneumonia?
Damla Geçkalan, Rahmi Özdemir, Yasin Yılmaz, Cemile Hilal Çelik, Batuhan Berk Demir, Yeşim Tunç
Journal of Health Sciences and Medicine, doi:10.32322/jhsm.1625339
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.
Conflict of Interest Statement The authors have no conflicts of interest to declare. Financial Disclosure The authors declared that this study has received no financial support. Author Contributions All of the authors declare that they have all participated in the design, execution, and analysis of the paper, and that they have approved the final version.
References
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Aktar, Sağır, Pediatric COVID-19 and its approach, Dicle Med J, doi:10.5798/dicletip.1005406
Asensio, Acunzo, Uribe, Recommendations for the measurement of the QT interval during the use of drugs for COVID-19 infection treatment. Updatable in accordance with the availability of new evidence, J Interv Card Electrophysiol, doi:10.1007/s10840-020-00765-3
Bebitoğlu, Oğuz, Hodzic, Oğuz, Hodzic et al., Chloroquine/hydroxychloroquine: pharmacological view of an old drug currently used in COVID-19 treatment, Anat Clin, doi:10.21673/anadoluklin.735826
Ben-Zvi, Kivity, Langevitz, Shoenfeld, Hydroxychloroquine: from malaria to autoimmunity, Clin Rev Allergy Immunol, doi:10.1007/s12016-010-8243-x
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Food&drug Adminastiration, drugs, drug safety and availability, FDA cautions against use of hydroxychloroquine or chloroquine for COVID-19 outside of the hospital setting or a clinical trial due to risk of heart rhythm problems
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Okour, Al-Kofahi, Hydroxychloroquine and azithromycin as potential treatments for COVID-19; clinical status impacts the outcome, J Pharmacokinet Pharmacodyn, doi:10.1007/s10928-020-09689-x
Retsema, Girard, Schelkly, Spectrum and mode of action of azithromycin (CP-62,993), a new 15-membered-ring macrolide with improved potency against gram-negative organisms, Antimicrob Agents Chemother, doi:10.1128/AAC.31.12.1939
Sarayani, Cicali, Henriksen, Brown, Safety signals for QT prolongation or torsades de pointes associated with azithromycin with or without chloroquine or hydroxychloroquine, Res Social Adm Pharm, doi:10.1016/j.sapharm.2020.04.016
Schrezenmeier, Dörner, Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology, Nat Rev Rheumatol, doi:10.1038/s41584-020-0372-x
Tisdale, Drug-induced QT interval prolongation and torsades de pointes: role of the pharmacist in risk assessment, prevention and management, Can Pharm J (Ott), doi:10.1177/1715163516641136
Wang, Hu, Hu, Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus-infected pneumonia in Wuhan, China, JAMA, doi:10.1001/jama.2020.1585
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Üzel, Yılmaz, Şen, Evaluation of hematological parameters of children diagnosed with COVID-19: single-center experience, Turk Arch Pediatr, doi:10.5152/TurkArchPediatr.2021.21076
DOI record: { "DOI": "10.32322/jhsm.1625339", "ISSN": [ "2636-8579" ], "URL": "http://dx.doi.org/10.32322/jhsm.1625339", "abstract": "<jats:p xml:lang=\"en\">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.\r\nMethods: 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.\r\nResults: 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. \r\nConclusion: 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.</jats:p>", "accepted": { "date-parts": [ [ 2025, 2, 25 ] ] }, "author": [ { "ORCID": "https://orcid.org/0000-0001-6344-7035", "affiliation": [ { "name": "Bakırçay Üniversitesi, Çiğli Eğitim ve Araştırma Hastanesi" } ], "authenticated-orcid": true, "family": "Geçkalan", "given": "Damla", "sequence": "first" }, { "ORCID": "https://orcid.org/0000-0002-2775-166X", "affiliation": [ { "name": "İZMİR KATİP ÇELEBİ ÜNİVERSİTESİ" } ], "authenticated-orcid": true, "family": "Özdemir", "given": "Rahmi", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0003-1724-9833", "affiliation": [ { "name": "KUTAHYA HEALTH SCIENCES UNIVERSITY" } ], "authenticated-orcid": true, "family": "Yılmaz", "given": "Yasin", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0002-8065-7082", "affiliation": [ { "name": "KUTAHYA HEALTH SCIENCES UNIVERSITY" } ], "authenticated-orcid": true, "family": "Çelik", "given": "Cemile Hilal", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0002-0349-5112", "affiliation": [ { "name": "KUTAHYA HEALTH SCIENCES UNIVERSITY" } ], "authenticated-orcid": true, "family": "Demir", "given": "Batuhan Berk", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0002-1078-8730", "affiliation": [ { "name": "KUTAHYA HEALTH SCIENCES UNIVERSITY" } ], "authenticated-orcid": true, "family": "Tunç", "given": "Yeşim", "sequence": "additional" } ], "container-title": "Journal of Health Sciences and Medicine", "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2025, 3, 26 ] ], "date-time": "2025-03-26T05:31:27Z", "timestamp": 1742967087000 }, "deposited": { "date-parts": [ [ 2025, 3, 26 ] ], "date-time": "2025-03-26T23:22:57Z", "timestamp": 1743031377000 }, "indexed": { "date-parts": [ [ 2025, 3, 26 ] ], "date-time": "2025-03-26T23:40:02Z", "timestamp": 1743032402477, "version": "3.40.3" }, "is-referenced-by-count": 0, "issue": "2", "issued": { "date-parts": [ [ 2025, 3, 21 ] ] }, "journal-issue": { "issue": "2", "published-online": { "date-parts": [ [ 2025, 3, 21 ] ] } }, "member": "17352", "original-title": [], "page": "308-312", "prefix": "10.32322", "published": { "date-parts": [ [ 2025, 3, 21 ] ] }, "published-online": { "date-parts": [ [ 2025, 3, 21 ] ] }, "publisher": "Journal of Health Sciences and Medicine", "reference": [ { "key": "ref1", "unstructured": "Kannan S, Shaik Syed Ali P, Sheeza A, Hemalatha K. COVID-19 (novel Coronavirus 2019)-recent trends. Eur Rev Med Pharmacol Sci. 2020; 24(4):2006-2011. doi:10.26355/eurrev_202002_20378" }, { "DOI": "10.1016/S0140-6736(20)30183-5", "doi-asserted-by": "crossref", "key": "ref2", "unstructured": "Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel Coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5" }, { "DOI": "10.5152/TurkArchPediatr.2021.21076", "doi-asserted-by": "crossref", "key": "ref3", "unstructured": "Üzel VH, Yılmaz K, Şen V, et al. Evaluation of hematological parameters of children diagnosed with COVID-19: single-center experience. Turk Arch Pediatr. 2021;56(5):463-468. doi:10.5152/TurkArchPediatr.2021. 21076" }, { "DOI": "10.1111/apa.15270", "doi-asserted-by": "crossref", "key": "ref4", "unstructured": "Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. 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COVID-19 in 7780 pediatric patients: a systematic review. eClinicalMedicine. 2020;24:100433. doi:10. 1016/j.eclinm.2020.100433" }, { "DOI": "10.23736/S2724-5276.21.06170-X", "doi-asserted-by": "crossref", "key": "ref34", "unstructured": "Hançerli Törün S, Kaba Ö, Sari Yanartas M, et al. Plasma D-dimer: a promising indicator of COVID-19 infection severity or only an acute phase reactant. Minerva Pediatr (Torino). 2021. doi:10.23736/S2724-5276.21.06170-X" }, { "DOI": "10.1056/NEJMc2005073", "doi-asserted-by": "crossref", "key": "ref35", "unstructured": "Lu X, Zhang L, Du H, et al. SARS-CoV-2 infection in children. 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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. IMA and WCH provide treatment protocols.
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