Is Azithromycin Cardiotoxic?

Is Azithromycin Cardiotoxic? A Danish study shows no excess cardiovascular-related mortality in relatively healthy azithromycin users. In a study published in 2012, exposure to azithromycin was associated with excess cardiovascular-related and all-cause mortality, compared with exposure to amoxicillin or no antibiotic; a postulated mechanism was QT prolongation (JW Gen Med May 22 2012 [Free full-text NEJM article PDF]). However, that study involved Medicaid recipients €” a low-income group with a potentially high prevalence of comorbidities. To determine whether the findings could be generalized, researchers performed a similar study using databases encompassing all young and middle-aged adults (age range, 18 €“64) in Denmark. Death rates during and immediately after 1.1 million episodes of azithromycin use were compared with death rates during similar numbers of episodes of no antibiotic use or penicillin V use. Propensity scoring was used to account for baseline clinical and demographic differences between the azithromycin, penicillin, and no-antibiotic groups. Current use of azithromycin, compared with no antibiotic use, was associated with excess risk for both cardiovascular- and noncardiovascular-related death. However, azithromycin use was not associated with excess mortality compared with penicillin V use. Comment: These findings suggest that the infections or other patient characteristics that prompted azithromycin prescriptions €” and not the drug itself €” accounted for the excess cardiovascular-related mortality; if azithromycin itself had been responsible, its use should have been associated with higher mortality than penicillin use. The difference between these Danish findings and the aforementioned U.S. findings could be explained by better overall health in the Danish cohort (their cardiovascular-related death rate was much lower). However, both studies included relatively few older adults, who would be especially vulnerable to cardiotoxicity. €” Allan S. Brett, MD Published in Journal Watch General Medicine May 1, 2013

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