CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

March 10th, 2014

Azithromycin, Levofloxacin Linked to Increased Risks for Arrhythmia and Mortality Compared with Amoxicillin

Azithromycin and levofloxacin carry higher arrhythmia and mortality risks than amoxicillin, according to an observational study in the Annals of Family Medicine. The FDA issued a cardiac warning on azithromycin in March 2013.

Researchers studied nearly 1.8 million U.S. veterans (mean age, 57) who received outpatient prescriptions for one of the three antibiotics from 1999 to 2012.  During treatment, patients receiving azithromycin had roughly a 50% increased risk for death and an 80% increased risk for serious arrhythmia, compared with those on amoxicillin. Risk increases were even greater for levofloxacin.

The researchers conclude: “There are usually multiple antibiotic choices available for older patients, especially those with cardiac comorbidities; physicians may consider prescribing medications other than azithromycin and levofloxacin.”

Categories: General, Prevention
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One Response to “Azithromycin, Levofloxacin Linked to Increased Risks for Arrhythmia and Mortality Compared with Amoxicillin”

  1. William DeMedio, MD says:
    March 10, 2014 at 10:36 pm

    I have not seen this as a clinically meaningful risk in well over 20 years of prescribing azithromycin. I have lso never seen any significant cardiac adverse effects with levofloxacin. I have seen many more cases of penicillin allergy and also clostridium difficile infection with many antibiotic. I never saw a fatality or otherwise seriously morbid adverse effect with any of the three antibiotics discussed.

    I feel antibiotics should be used where the benefit outweighs the risks. I would not be wary of the use of any of them where they are necessary.