May 17th, 2012
Azithromycin Associated with Cardiovascular Death
The antibiotic azithromycin — which may have proarrhythmic properties — is associated with increased risk for cardiovascular death, according to a retrospective cohort study in the New England Journal of Medicine.
The study, in a Medicaid population, included nearly 350,000 azithromycin prescriptions, 1.4 million control periods without antibiotic prescriptions, and 1.8 million prescriptions for other antibiotics, mostly amoxicillin.
Azithromycin conferred a nearly threefold increase in risk for CV death and a nearly twofold increase in all-cause mortality during the 5 days of therapy, relative to no treatment. When azithromycin and amoxicillin were compared, there were 47 excess CV deaths per 1 million courses of azithromycin. For patients with the highest CV risk at baseline, there were 245 excess deaths per 1 million azithromycin treatments, compared with amoxicillin.
Azithromycin also posed greater risk for CV mortality compared with ciprofloxacin, but not compared with levofloxacin.
In HIV and ID Observations, Dr. Paul Sax writes: “If there’s a silver lining to this report … it’s that clinicians will stop prescribing azithromycin for conditions that clearly don’t need it — which is just about every uncomplicated outpatient respiratory infection. … Hey, we can dream, can’t we?”
NEJM article (Free abstract)
HIV and ID Observations blog (Free)