Ceftriaxone and Lansoprazole Combo linked to Increased Adverse Cardiac Events: JAMA

In a recent study, the combination of ceftriaxone, an antibiotic, and lansoprazole, a proton pump inhibitor (PPI), has been found to have concerning effects on cardiac health. While it's known to prolong the corrected QT interval on electrocardiograms, the study published in Journal of American Medical Association delves into whether this translates into clinically significant patient outcomes.

Researchers conducted a retrospective cohort study spanning from January 1, 2015, to December 31, 2021, involving adult medical inpatients in 13 hospitals in Ontario, Canada, who were administered ceftriaxone along with either lansoprazole or another PPI. The primary objective was to compare the risk of ventricular arrhythmia, cardiac arrest, and in-hospital mortality between these two groups.

Of the 31,152 patients who received ceftriaxone in conjunction with a PPI, the study revealed that ventricular arrhythmia or cardiac arrest was more prevalent in those administered lansoprazole. Within the lansoprazole group, 3.4% of patients experienced these adverse cardiac events compared to 1.2% in the group taking other PPIs. Additionally, in-hospital mortality was notably higher in the lansoprazole group, with 19.9% of patients succumbing to it, as opposed to 10.1% in the group using other PPIs.

To ensure the results were robust, propensity-score weighting was employed to account for various factors including demographic characteristics, comorbidities, and other relevant variables.

The adjusted risk difference, after accounting for these factors, highlighted a 1.7% higher risk of ventricular arrhythmia or cardiac arrest for those in the lansoprazole group. More alarmingly, the risk of in-hospital mortality was found to be 7.4% higher in the lansoprazole group compared to the other PPI group.

This study raises important concerns about the combination of lansoprazole and ceftriaxone in patient care. The findings suggest that this combination therapy should be avoided due to the increased risk of adverse cardiac events and mortality. It's important to note that while this study provides significant insights, further research is needed to determine if these findings hold in other patient populations and healthcare settings.

Reference:

Bai, A. D., Wilkinson, A., Almufleh, A., Rai, M., Razak, F., Verma, A. A., & Srivastava, S. (2023). Ceftriaxone and the Risk of Ventricular Arrhythmia, Cardiac Arrest, and Death Among Patients Receiving Lansoprazole. In JAMA Network Open (Vol. 6, Issue 10, p. e2339893). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2023.39893