Is There an Association Between Azithromycin and CV Events Among Older Pneumonia Patients?

According to the 2012 National Vital Statistics Reports, pneumonia and influenza together are the leading cause of infectious death in the U.S. and the eighth cause of all death. Current clinical practice guidelines suggest treating hospitalized pneumonia patients with macrolides in combination with azithromycin to combat these infections. Although empirical evidence suggests that this combination therapy is an effective treatment plan, recent research hypothesizes that azithromycin may be associated with increased risk of cardiovascular events.

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In a study published June 3 in the Journal of the American Medical Association, a team led by Eric Mortensen, MD, sought to examine the association of azithromycin use and patient outcomes within 90 days of hospital admission, including cardiovascular events in hospitalized pneumonia patients over the age of 65. The researchers found that the overall death rate among older patients was significantly lower in those who took azithromycin compared with other antibiotics, but their risk of myocardial infarction was slightly higher.

The team performed a retrospective cohort study using national Department of Veterans Affairs (VA) administrative data of all pneumonia patients aged 65 or older hospitalized at any VA hospital from fiscal years 2002-2012. Of the 73,690 patients involved in the study, 50 percent were prescribed azithromycin therapy and the other half received other guideline-concordant antibiotic therapy.

The researchers found that 90-day mortality was significantly lower in those who received azithromycin (17.4 percent vs 22.3 percent). Those patients also had increased odds of heart attack (5.1 percent vs 4.4 percent), but not any cardiac event (43.0 percent vs 42.7 percent), cardiac arrhythmias (25.8 percent vs 26.0 percent) or heart failure (26.3 percent vs 26.2 percent).

In this national cohort study, azithromycin use was found to be associated with lower mortality and slightly higher odds of myocardial infarction. "To put the balance of benefits and harms in context, based on the propensity-matched analysis, the number needed to treat with azithromycin was 21 to prevent one death within 90 days, compared with a number needed to harm of 144 for myocardial infarction. This corresponds to a net benefit of around seven deaths averted for one nonfatal myocardial infarction induced," the authors note.

They add that their findings "are consistent with a net benefit associated with azithromycin use in patients hospitalized for pneumonia."

Keywords: Myocardial Infarction, Influenza, Human, Pneumonia, Vital Statistics, Heart Failure, Macrolides, Azithromycin

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