Title: New Data: Azithromycin and Levofloxacin and Cardiovascular Risk<br/>Author: Bryan Hayes<br/><a href='http://umem.org/profiles/faculty/369/'>[Click to email author]</a><hr/><p>
A new study of almost 2 million prescriptions in VA patients compared the risk of cardiovascular death or dysrhythmia in patients receiving azithromcyin, levofloxacin, and amoxicillin.</p>
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<strong>What they found</strong></p>
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Compared with amoxicillin, <u>azithromycin</u><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.999801635742188px;"> resulted in a significant increase in mortality </span><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.999801635742188px;">(</span><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.999801635742188px;">HR = 1.48; 95% CI, 1.05-2.09) </span><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.999801635742188px;">and dysrhythmia risk </span><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.999801635742188px;">(HR = 1.77; 95% CI, 1.20-2.62) </span><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.999801635742188px;">on days 1 to 5, but not 6 to 10</span><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.999801635742188px;">. </span></p>
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<span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.999801635742188px;"><u>Levofloxacin</u> resulted in an increased risk</span><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.999801635742188px;"> throughout the 10-day period. Days 1-5 mortality </span><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.999801635742188px;">(HR = 2.49, 95% CI, 1.7-3.64) and serious cardiac dysrhythmia (HR = 2.43, 95% CI, 1.56-3.79). Days 6-10 mortality</span><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.999801635742188px;"> (HR = 1.95, 95% CI, 1.32-2.88) and dysrhythmia (HR = 1.75; 95% CI, 1.09-2.82).</span></p>
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<strong style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.999801635742188px;">Important limitations</strong></p>
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<span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.999801635742188px;">This study did not have a comparator group of patients getting no antibiotics. Previous data suggest patients on any antibiotic (eg, penicillin) have a higher risk of death or dysrhythmia.</span></p>
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<font color="#000000" face="arial, helvetica, clean, sans-serif" size="2"><span style="line-height: 17.999801635742188px;">The <a href="http://www.annfammed.org/content/12/2/121/suppl/DC1">supplemental index</a> shows that patients receiving azithromycin and levofloxacin had more serious infections (eg, PNA, COPD, etc.) which may have put them at higher risk for worse outcome irrespective of antibiotic choice.</span></font></p>
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<strong style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.999801635742188px;">What it means</strong></p>
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<span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.999801635742188px;">It seems azithromycin and levofloxacin do contribute to a small increase</span><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.999801635742188px;"> in cardiovascular mortality and dysrhythmia during their use. </span><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.999801635742188px;">A previous study found this is more likely in those with existing cardiovascular disease.</span></p>
<fieldset><legend>References</legend>
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Rao GA, et al. Azithromyicin and levofloxacin use and increased risk of cardiac arrhythmia and death. <em>Ann Fam Med</em> 2014;12(2):121-7. [<a href="http://www.ncbi.nlm.nih.gov/pubmed/24615307">PMID 24615307</a>]</p>
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