Combined Use of a Fluoroquinolone and Bedaquiline in Children with Multidrug-Resistant Respiratory Tuberculosis from the Standpoint of Cardiotoxicity

The objective: to evaluate the effect of combined use of a fluoroquinolone and bedaquiline on the QT interval length when added to chemotherapy regimens in children with multidrug-resistant respiratory tuberculosis.

Subjects and Methods. A retrospective, selective comparative study (2018-2022) was conducted among two groups of children aged 6-12 years with multidrug-resistant respiratory tuberculosis: Main Group (MG) consisted of 13 children who received two drugs with a cardiotoxic effect (bedaquiline and a fluoroquinolone) in their chemotherapy regimen; while 13 children who received a chemotherapy regimen containing a fluoroquinolone only were included in Comparison Group (CG). During the study, a standard ECG was performed assessing the length of the QT_с interval.

Results. Prolongation of the QT_с interval was a frequent (84.6%) adverse reaction (AR) in children from MG and it was observed statistically significantly less frequently (15.4%) in CG, p<0.001. The number of episodes of the QT_с interval prolongation was also reported significantly more frequently in MD versus GS: 36 (23.8%) cases out of 151 examinations and 6 (4.2%) out of 144 examinations, respectively, χ2=23.367, p≤0.001. The range of deviations of the QT_с interval from the reference value (440 ms) did not exceed 460 ms in MG in 28/36 (77.8%) episodes, in CG – in 6/6 (100%) episodes. Prolongation of the QT_с interval from 461 ms and more was recorded only in MG – 8/36 (22.2%). And only 1/13 (7.7%) patient from MG had a prolongation of the QT_с interval to 512 ms. In no case the prolongation of the QT_с interval was accompanied by clinical symptoms; no electrolyte disturbances, changes in liver or kidney function, or paroxysmal rhythm disturbances were observed. 

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