Study #1: [1]
What they Did:
- Retrospective, Observational Cohort Study
- Tennessee Medicaid Cohort
- Compared
-
- No antibiotics (1,391,180 prescriptions)
- Azithromycin (347,795 prescriptions)
- Amoxicillin (1,348,672 prescriptions)
- Detect an increased risk of death
Primary Outcomes:
- Cardiovascular death
- Death from any cause
Results:
- Cardiovascular Risk Factors in This Study: Smoking, high BMI, poor diet, and low physical activity
- NO statistically significant risk of death after the 5 day course of azithromycin completed
Limitation:
- Observational, non-randomized clinical trial
Conclusion: During 5 days of azithromycin therapy, there is a small absolute increase in cardiovascular deaths and most pronounced in patients with a high baseline risk of cardiovascular disease
Study #2: [2]
What they Did:
- Retrospective, Observational Cohort Study
- Danish Adults
- Compared
-
- No antibiotics vs Azithromycin (1,102050 prescriptions compared in 1:1 ratio)
- Azithromycin vs Pencillin V (1,102,419 prescriptions vs 7,364,292 prescriptions)
Primary Outcomes:
- Cardiovascular Death
Results:
- No increase in cardiovascular death with recent or past use of azithromycin
- No increase in cardiovascular death in patients with no history of cardiovascular disease
- There is an increase in cardiovascular death in patients with a history of cardiovascular disease
Limitations:
- Did not have information of known risk factors for cardiovascular disease (smoking and BMI)
- Number of events in the subgroup analysis is low
Conclusion: Azithromycin use is not associated with an increased risk of death from cardiovascular causes in a general population of young and middle-aged adults
Take Home Points:
- In the second study the patient population had better cardiovascular health than the first study
- The increased cardiovascular risk may be from the systemic infectious process and not azithromycin itself
- You can still prescribe azithromycin, but remember the small increased risk of death in patients with cardiovascular disease and/or > 65 years of age
References:
- Ray WA et al. Azithromycin and the Risk of Cardiovascular Death. NEJM 2012. PMID: 22591294
- Svanstrom H et al. Use of Azithromycin and Death from Cardiovascular Causes. NEJM 2013. PMID: 23635050
For more on this topic:
- Listen to the podcast with my good friend Ken Milne over at The Skeptics Guide to Emergency Medicine: SGEM#76: And the Beat Goes On (Azithromycin and Risk of Cardiovascular Death)
- Josh Farkas at PulmCrit: Brief Rant – Still no Evidence That Azithromycin Increases Mortality
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