Cardiovascular side-effects of common antibiotics

Two of the most prescribed classes of antibiotic in respiratory medicine, macrolides and fluoroquinolones, are associated with cardiovascular side-effects. The antibiotic-related cardiovascular morbidity and mortality are linked to arrhythmia, ischaemic events, and aortic dissection or bleeding. However, the cardiovascular risk of antibiotics is higher in the subgroup of patients with risk factors for arrhythmia, ischaemic CVEs and aortic dissection. Therefore, identifying this subgroup of patients at high risk is of paramount importance. The aim of this chapter is to review antibiotic-induced adverse CVEs, particularly in high-risk patients. The mechanisms inducing these events and the gaps in real-life data are also explored. Finally, we propose an algorithm to identify patients at risk for CVEs and to monitor those undergoing macrolide and fluoroquinolone treatment.