The antibiotic azithromycin \u2014 which may have proarrhythmic properties \u2014 is associated with increased risk for cardiovascular death, according to a retrospective cohort study in the New England Journal of Medicine.<\/p>\n
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.<\/p>\n
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.<\/p>\n
Azithromycin also posed greater risk for CV mortality compared with ciprofloxacin, but not compared with levofloxacin.<\/p>\n
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 \u2014 which is just about every uncomplicated outpatient respiratory infection. … Hey, we can dream, can’t we?”<\/p>\n
NEJM article<\/a> (Free abstract)<\/p>\n