Azithromycin
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Wide QRS complex tachyarrhythmia following off-label use: case report A 58-year-old man developed wide QRS complex tachyarrhythmia following an off-label treatment with azithromycin for coronavirus disease 2019 (COVID-19). The man, with a history of arthralgia and Waldenstrom macroglobulinemia, was receiving treatment with ibrutinib for WM for 85 months. Subsequently, he developed symptoms of cough, fever, and sore throat for 5 days and was hospitalised due to progressive dyspnoea and hypoxia. He was diagnosed with COVID-19. His hypoxia acutely worsened, requiring supplemental oxygen use. Subsequently, he started receiving off-label treatment with hydroxychloroquine and azithromycin [route and dosage not stated]. However, azithromycin was discontinued 3 days later, due to development of wide QRS complex tachyarrhythmia. The man received hydroxychloroquine for 5 days. Hypoxia continued to worsen and fever persisted during hydroxychloroquine course. Thus, ibrutinib the previously discontinued ibrutinib was restarted along with off-label tocilizumab 400mg on day 5 of admission. He received IV immune-globulin [immunoglobulin] from day 6–10 of admission. On day 10, he experienced worsening hypoxia that was accompanied by elevated CRP and required mechanical ventilation. Ibrutinib dose was increased on day 11–12. A rapid improvement in oxygenation followed, and he was successfully extubated on day 12. On day 14, after improved oxygen saturation and decreased CRP level, he was discharged home with continued treatment with ibrutinib [outcome not stated]. Treon SP, et al. The BTK inhibitor ibrutinib may protect against pulmonary injury in COVID-19 infected patients. Blood 135: 1912-1915, No. 21, May 2020. Available from: 803504788 URL: http://doi.org/10.1182/BLOOD.2020006288
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Reactions 3 Oct 2020 No. 1824
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