Azithromycin associated with greater risk of cardiovascular death, but not sudden cardiac death
Outpatient prescriptions for azithromycin are associated with an increased risk of cardiovascular mortality, according to new research published in JAMA Network Open.
The common antibiotic has long been associated with adverse cardiovascular outcomes—its labeling indicates it should not be prescribed to patients with risk factors for ventricular arrhythmia—and it was one of the medications viewed as a potential COVID-19 treatment in March and April 2020. This newest study tracked the outpatient use of azithromycin by patients between the ages of 30 and 74 years old, comparing its performance with another common antibiotic, amoxicillin.
The authors explored data from more than 2 million U.S. patients who received care from 1998 to 2014. While 22.2% of the cohort were given azithromycin, the other 77.8% were given amoxicillin. Overall, azithromycin was associated with “a significantly increased hazard of cardiovascular death, but not sudden cardiac arrest within five days of exposure.” Six to ten days after taking the medications, the research team found “no increases in risk.”
Patients prescribed azithromycin also had a higher risk of noncardiovascular death within five days. The most common noncardiovascular deaths observed among the study participants were lung disease, infection, cancer and diabetes. Causality could not be established, the authors noted.
“This cohort study found an approximately two-fold increased risk of cardiovascular death and noncardiovascular death after outpatient azithromycin use compared with use of amoxicillin within a five-day window after dispensing,” wrote lead author Jonathan G. Zaroff, MD, Kaiser Permanente Northern California, and colleagues. “Although these analyses cannot establish causality, prescribers should be aware of this potential association.”
The full study is available here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.