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July 4, 1977

Anthracycline Antibiotics and the Heart

JAMA. 1977;238(1):60. doi:10.1001/jama.1977.03280010060027

Whenever we prescribe antimicrobial antibiotic, our attention is usually focused on the kidney more than any other organ because of its exposure to high concentrations of the drug by glomerular filtration and tubular reabsorption. Sometimes, as with antibiotics of the tetracycline group, we worry about the gastrointestinal tract, which may become vulnerable to injury by commensals. Frequently, we may be concerned with injury to the blood cells or the liver. Rarely, if ever, do we think of the heart as a target of antibiotic toxicity.

With the advent of antitumor antibiotics of the anthracycline group, the heart lost its privileged position vis-à-vis other organs. It, too, became vulnerable. An increasing number of reports have attested to this vulnerability since Tan et al1 reported lethal cardiotoxicity in seven children, and Ainger et al2 described a similar fatal outcome in two adults, in whom electronmicroscopic study of the myocardium demonstrated