A Danish study shows no excess cardiovascular-related mortality in relatively healthy azithromycin users.

In a study published in 2012, exposure to azithromycin was associated with excess cardiovascular-related and all-cause mortality, compared with exposure to amoxicillin or no antibiotic; a postulated mechanism was QT prolongation (JW Gen Med May 22 2012). However, that study involved Medicaid recipients — a low-income group with a potentially high prevalence of comorbidities. To determine whether the findings could be generalized, researchers performed a similar study using databases encompassing all young and middle-aged adults (age range, 18–64) in Denmark. Death rates during and immediately after 1.1 million episodes of azithromycin use were compared with death rates during similar numbers of episodes of no antibiotic use or penicillin V use. Propensity scoring was used to account for baseline clinical and demographic differences between the azithromycin, penicillin, and no-antibiotic groups.

Current use of azithromycin, compared with no antibiotic use, was associated with excess risk for both cardiovascular- and noncardiovascular-related death. However, azithromycin use was not associated with excess mortality compared with penicillin V use.

CITATION(S):

Svanström H et al. Use of azithromycin and death from cardiovascular causes. N Engl J Med 2013 May 2; 368:1704.