Common Antibiotic Linked to Increased Risk of Cardiovascular Death

Results of a recent study link the use of azithromycin with increased short-term cardiovascular-related and all-cause mortality risk.

Previous studies have raised concerns about cardiovascular effects with the use of azithromycin, leading to a labeling change by the FDA which advised against its use in patients with risk factors for ventricular arrhythmia.

The researchers conducted a retrospective cohort study including data from 2 large, diverse, community-based integrated care delivery systems with 7,824,681 antibiotic exposures, (1,736,976 azithromycin exposures and 6,087,705 amoxicillin exposures among 2,929,008 individuals). The primary outcomes of the study were cardiovascular death and sudden cardiac death. Secondary outcomes were non-cardiovascular death and all-cause mortality.

Overall, the researchers observed a significant association between azithromycin use and increased risk of cardiovascular death (hazard ratio [HR] 1.82; 95% CI, 1.23-2.67) within 5 days of exposure. Increases were not observed 6 to 10 days after exposure.

Results were similar in patients within the top decile of cardiovascular risk. Use of azithromycin was also associated with increased non-cardiovascular death (HR 2.17; 95% CI, 1.44-3.26) and all-cause mortality (HR 2.00; 95% CI, 1.51-2.63) within 5 days of exposure.

“This cohort study found an approximately 2-fold increased risk of cardiovascular death and non-cardiovascular death after outpatient azithromycin use compared with use of amoxicillin within a 5-day window after dispensing. Although these analyses cannot establish causality, prescribers should be aware of this potential association,” the researchers concluded.

—Michael Potts

Reference:

Zaroff JG, Cheetham TC, Palmetto N, et al. association of azithromycin use with cardiovascular mortality. Published online June 17, 2020. JAMA Netw Open. 2020;3(6):e208199. doi:10.1001/jamanetworkopen.2020.8199