Can hydroxychloroquine and azithromycin combination cause cardiac rhythm disturbances in children with COVID-19 pneumonia?

Aims: At the beginning of the COVID-19 pandemic; it has been shown that receiving hydroxychloroquine and azithromycin treatment decrease viral carriage of coronavirus in patients. In this study, we aimed to evaluate electrocardiography (ECG) abnormalities in pediatric patients with COVID-19 pneumonia receiving combined therapy with hydroxychloroquine and azithromycin. Methods: In this study; ECG and laboratory parameters of 24 children with COVID-19 pneumonia who were treated with hydroxychloroquine and azithromycin at Health Sciences University between June 2020 and November 2020 were analyzed retrospectively. P wave dispersion (PWd), QT interval (QT), QT dispersion (QTd), QTc interval (QTc), QTc dispersion (QTcd), Tpeak-Tend interval (Tp-e), Tp-e dispersion (Tp-ed), Tp-e/QT, Tp-Te/QTc ratios were evaluated with 12 lead ECG. ECG parameters and QTc interval were compared before and after (5 days) the treatment. Results: The mean age was 13±4.5 years and 62.5% were female. Median hospitalization length was 6 days. There was no statistically significant difference between the PWd, QT and QTc interval, QTd, QTcd, Tp-e interval, Tp-e dispersion, Tp-e/QT, Tp-e/QTd measurements and ratios of the before and after treatment. A significant difference was found for the decrease in hearth rate in regard to the measurement before and after the treatment. Conclusion: In our study, there were no rhythm problems which were observed on ECG in pediatric patients receiving hydroxychloroquine and azithromycin combination therapy for COVID-19 pneumonia. We also found that laboratory parameters were not specific for COVID-19 pneumonia in children.