Seniors with Pneumonia Lower Death Risk Taking
Azithromycin; Slight Chance of Heart Attack
Study suggests the protection from pneumonia
outweighs the heart attack risk see video
3, 2014 - In a study that included nearly 65,000 senior patients age
65 and older - hospitalized with pneumonia, treatment that included
azithromycin compared with other antibiotics was associated with a
significantly lower risk of death and a slightly increased risk of heart
attack, according to a study in the June 4 issue of JAMA.
Pneumonia and influenza together are the eighth
leading cause of death and the leading causes of infectious death in the
Although clinical practice guidelines recommend
combination therapy with macrolides (a class of antibiotics), including
azithromycin, as first-line therapy for patients hospitalized with
pneumonia, recent research suggests that azithromycin may be associated
with increased cardiovascular events, according to background
information in the article.
Eric M. Mortensen, M.D., M.Sc., of the VA North
Texas Health Care System and University of Texas Southwestern Medical
Center, Dallas, and colleagues assessed the association of azithromycin
use and outcomes within 90 days of hospital admission, including
cardiovascular events (heart failure, heart attack, cardiac arrhythmias)
and death, for patients 65 years and older who were hospitalized with
pneumonia at any Veterans Administration acute care hospital from fiscal
years 2002 through 2012.
The final analysis included 31,863 patients who
received azithromycin and 31,863 matched patients who did not, but some
other guideline-concordant therapy.
The researchers found that 90-day mortality was
significantly lower in those who received azithromycin (17.4 percent, vs
22.3 percent). There was also an 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 of veterans
hospitalized with pneumonia, azithromycin use was consistently
associated with decreased mortality and a slightly increased odds of
myocardial infarction, the authors write.
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 1 death within 90 days,
compared with a number needed to harm of 144 for myocardial infarction.
This corresponds to a net benefit of around 7 deaths averted for 1
nonfatal myocardial infarction induced.
These findings are consistent with a net benefit
associated with azithromycin use in patients hospitalized for
Why is this medication
Azithromycin is used to treat
certain bacterial infections, such as bronchitis; pneumonia; sexually
transmitted diseases (STD); and infections of the ears, lungs, sinuses,
skin, throat, and reproductive organs. Azithromycin also is used to
treat or prevent disseminated Mycobacterium avium complex (MAC)
infection [a type of lung infection that often affects people with human
immunodeficiency virus (HIV)]. Azithromycin is in a class of medications
called macrolide antibiotics. It works by stopping the growth of
bacteria. Antibiotics will not kill viruses that can cause colds, flu,
or other infections.
Azithromycin is also used sometimes
to treat H. pylori infection, travelers' diarrhea, and other
gastrointestinal infections; Legionnaires' disease (a type of lung
infection); pertussis (whooping cough; a serious infection that can
cause severe coughing); and babesiosis (an infectious disease carried by
ticks). It is also used to prevent heart infection in people having
dental or other procedures, and to prevent STD in victims of sexual
assault. Talk to your doctor about the possible risks of using this
medication for your condition.
This medication may be prescribed
for other uses; ask your doctor or pharmacist for more information.
FDA Drug Safety Communication:
Azithromycin (Zithromax or Zmax) and the risk of potentially fatal heart
The U.S. Food and Drug Administration (FDA) is warning the public that
azithromycin (Zithromax or Zmax) can cause abnormal changes in the
electrical activity of the heart that may lead to a potentially fatal
irregular heart rhythm. Patients at particular risk for developing this
condition include those with known risk factors such as existing QT
interval prolongation, low blood levels of potassium or magnesium, a
slower than normal heart rate, or use of certain drugs used to treat
abnormal heart rhythms, or arrhythmias.