Home > Journal Club > Journal Club 25 July 2012

Journal Club 25 July 2012

Paper

Azithromycin and the Risk of Cardiovascular Death

Presenter

LAM

Summary

Abstract from paper:

BACKGROUND

Although several macrolide antibiotics are proarrhythmic and associated with an increased
risk of sudden cardiac death, azithromycin is thought to have minimal cardiotoxicity.
However, published reports of arrhythmias suggest that azithromycin
may increase the risk of cardiovascular death.

METHODS

We studied a Tennessee Medicaid cohort designed to detect an increased risk of death
related to short-term cardiac effects of medication, excluding patients with serious
noncardiovascular illness and person-time during and shortly after hospitalization.
The cohort included patients who took azithromycin (347,795 prescriptions),
propensity-score–matched persons who took no antibiotics (1,391,180 control periods),
and patients who took amoxicillin (1,348,672 prescriptions), ciprofloxacin
(264,626 prescriptions), or levofloxacin (193,906 prescriptions).

RESULTS

During 5 days of therapy, patients taking azithromycin, as compared with those who
took no antibiotics, had an increased risk of cardiovascular death (hazard ratio, 2.88;
95% confidence interval [CI], 1.79 to 4.63; P<0.001) and death from any cause (hazard
ratio, 1.85; 95% CI, 1.25 to 2.75; P = 0.002). Patients who took amoxicillin had
no increase in the risk of death during this period. Relative to amoxicillin, azithromycin
was associated with an increased risk of cardiovascular death (hazard ratio,
2.49; 95% CI, 1.38 to 4.50; P = 0.002) and death from any cause (hazard ratio, 2.02;
95% CI, 1.24 to 3.30; P = 0.005), with an estimated 47 additional cardiovascular deaths
per 1 million courses; patients in the highest decile of risk for cardiovascular disease
had an estimated 245 additional cardiovascular deaths per 1 million courses.
The risk of cardiovascular death was significantly greater with azithromycin than
with ciprofloxacin but did not differ significantly from that with levofloxacin.

CONCLUSIONS

During 5 days of azithromycin therapy, there was a small absolute increase in cardiovascular
deaths, which was most pronounced among patients with a high baseline
risk of cardiovascular disease.

Appendix information is available here.

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