Disclosures: One author reports she is an employee of Boehringer Ingelheim and another reports she is an employee of Aetion. The other authors report no relevant financial disclosures.
June 17, 2020
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Azithromycin confers twofold greater 5-day CV mortality risk vs. amoxicillin

Disclosures: One author reports she is an employee of Boehringer Ingelheim and another reports she is an employee of Aetion. The other authors report no relevant financial disclosures.
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Outpatient use of the antibiotic azithromycin was associated with greater 5-year risk for CV death, non-CV death and all-cause mortality compared with amoxicillin, researchers reported.

Patients prescribed azithromycin were more likely to also have been prescribed cardioprotective medications or have pneumonia, chronic obstructive pulmonary disease or asthma in the year before prescription compared with those prescribed amoxicillin. Researchers could not establish causality for the relationship between azithromycin use and death.

Antibiotics
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Researchers analyzed patients (mean age, 51 years; 62% women) who were prescribed azithromycin (22%) or amoxicillin (78%), excluding patients with absence of prescription benefits; use of more than one type of antibiotic within 10 days; hospitalization or nursing home residence or serious medical conditions.

Overall, azithromycin was more frequently prescribed for pulmonary infections whereas amoxicillin was more frequently prescribed for ear, nose and throat infections.

Within 5 days of exposure, outpatient use of azithromycin was associated with greater risk for CV death (HR = 1.82; 95% CI, 1.23-2.67), non-CV death (HR = 2.17; 95% CI, 1.44-3.26) and all-cause mortality (HR = 2; 95% CI, 1.51-2.63), but not sudden cardiac death (HR = 1.59; 95% CI, 0.9-2.81) compared with amoxicillin.

Results for CV death risk were similar among patients who were at elevated CV risk at baseline (HR = 1.71; 95% CI, 1.06-2.76).

According to the study, the risk for CV death and sudden cardiac death 6 to 10 days after azithromycin exposure was nonsignificant compared with amoxicillin exposure.

“This cohort study found an approximately twofold increased risk of cardiovascular death and noncardiovascular death after outpatient azithromycin use compared with use of amoxicillin within a 5-day window after dispensing,” Jonathan G. Zaroff, MD, cardiologist in the division of research at Kaiser Permanente Northern California, Oakland, and colleagues wrote. “Although these analyses cannot establish causality, prescribers should be aware of this potential association.”