title: Exposure to antibacterial agents with QT liability in 14 European countries: trends over an 8-year period.
abstract: OBJECTIVE
  (i) To classify antibacterial agents with QT liability on the basis of the available evidence, and (ii) to assess trends in their consumption over an 8-year period (1998-2005) in 14 European countries.
  
  
  METHODS
  Current published evidence on QT liability of antibiotics was retrieved through MEDLINE search and joined to official warnings from regulatory agencies. Each drug was classified according to an already proposed algorithm based on the strength of evidence: from group A (any evidence) to group E (clinical reports of torsades de pointes and warnings on QT liability). Consumption data were provided by the European Surveillance of Antibacterial Consumption (ESAC) project and were expressed as defined daily doses per 1000 inhabitants per day (DID).
  
  
  RESULTS
  Among 21 detected compounds, nine [six fluoroquinolones (FQs) and three macrolides (MACs)] belonged to group E. Use of group E drugs ranged from 1.3 (Sweden) to 4.1 DID (Italy) in 1998 and from 1.2 (Sweden) to 6.5 DID (Italy) in 2005. Significant exposure was observed in Italy and Spain (6.5 and 3.8 DID, respectively, in 2005). Only Denmark, Sweden and UK showed a slight decrease in use. Exposure to clarithromycin increased in 10 out of 14 countries, with a marked increment in Italy (3 DID in 2005).
  
  
  CONCLUSIONS
  Notwithstanding regulatory measures, in 2005 there was still significant exposure to antibacterials with strong evidence of QT liability and, in most countries, it was even increased. This warrants further investigation of appropriateness of use and suggests closer monitoring of group E drugs. Physicians should be aware when prescribing them to susceptible patients.
authors.affiliation: Department of Pharmacology, University of Bologna, Bologna, Italy.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Raschi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Poluzzi
authors.forename: Chiara
authors.initials: C
authors.lastname: Zuliani
authors.forename: Arno
authors.initials: A
authors.lastname: Muller
authors.forename: Herman
authors.initials: H
authors.lastname: Goossens
authors.forename: Fabrizio
authors.initials: F
authors.lastname: De Ponti
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000145:classification; D001145:Arrhythmias, Cardiac / Q000139:chemically induced*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004562:Electrocardiography / Q000187:drug effects; D005060:Europe; D006801:Humans
chemical_list: D000900:Anti-Bacterial Agents