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Use of Azithromycin and Death From Cardiovascular Causes
Study Questions:
Does azithromycin increase the risk of cardiovascular death in young and middle-aged adults?
Methods:
Data for this study were obtained from national registries in Denmark. Individuals who received prescriptions for azithromycin or penicillin V were identified. Individuals who did not receive a prescription for an antibiotic served as a control group. Propensity matching was performed to control for confounding variables. The primary outcome was cardiovascular death.
Results:
For the comparison of azithromycin versus no antibiotic, there were 1,102,050 individuals (mean age 39 years) in the azithromycin group and in the no antibiotic group. Compared to no antibiotic therapy, the use of azithromycin was associated with a 2.85-fold higher risk of cardiovascular death. For the comparison of azithromycin versus penicillin V, the sample sizes of the propensity-matched cohorts were 1,102,419 individuals in the azithromycin group and 7,364,292 in the penicillin V group. Compared to penicillin V, the use of azithromycin was not associated with a significantly higher risk of cardiovascular death.
Conclusions:
Compared to penicillin V, azithromycin does not increase the risk of cardiovascular death in young and middle-aged individuals.
Perspective:
Azithromycin is less likely than other macrolide antibiotics such as erythromycin or clarithromycin to cause QT prolongation. Nevertheless, there have been cases of QT-related cardiac events attributed to azithromycin, and a prior study reported a 2.5-fold higher risk of cardiovascular death with azithromycin compared to amoxicillin in a Medicaid population. In that study, the risk of cardiovascular death was related to risk factors for cardiovascular disease. The present study provides reassuring evidence that azithromycin can be used safely in a low-risk cohort of patients seen in general practice.
Keywords: Denmark, Medicaid, Azithromycin, Clarithromycin, Pharyngitis, Cause of Death, Erythromycin, Penicillin V, Middle Aged, Macrolides, Cardiovascular Diseases, Streptococcus pyogenes, Streptococcal Infections
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