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Azithromycin linked to more MI, less death in older adults with pneumonia
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In a study of nearly 65,000 older adults hospitalized with pneumonia, treatment that included azithromycin was associated with a significantly lower risk for death at 90 days and a small increased risk for MI vs. treatment with other antibiotics.
The retrospective, population-based cohort study included data from 118 hospitals in the Veterans Affairs health care system. Of 73,690 patients identified, the researchers composed propensity-matched groups of 31,863 patients exposed to azithromycin and 31,863 patients who were not exposed to azithromycin. All patients were aged at least 65 years, hospitalized for pneumonia between October 2001 and September 2012, and received antibiotic therapy based on national clinical practice guidelines, according to the study.
“Although clinical practice guidelines recommend combination therapy with macrolides, including azithromycin, as first-line therapy for patients hospitalized with pneumonia, recent research suggests that azithromycin may be associated with increased cardiovascular events,” Eric M. Mortensen, MD, MSc, from the section of general internal medicine at Dallas VA Medical Center, and colleagues wrote.
Propensity score matching revealed no significant disparities in potential confounders between the azithromycin and other antibiotic therapy.
The mortality rate at 90 days was significantly lower among patients who received azithromycin compared with those who received other antibiotic therapy (17.4% vs. 22.3%; OR=0.73; 95% CI, 0.7-0.76). Azithromycin users, however, had a significantly increased likelihood of MI compared with users of other antibiotics (5.1% vs. 4.4%; OR=1.17; 95% CI, 1.08-1.25). Azithromycin was not associated with higher risk for any cardiac event (43% vs. 42.7%; OR=1.01; 95% CI, 0.98-1.05), cardiac arrhythmias (25.8% vs. 26%; OR=0.99; 95% CI, 0.95-1.02) or HF (26.3% vs. 26.2%; OR=1.01; 95% CI, 0.97-1.04), according to the study results.
The researchers said these data are indicative of an aggregate benefit associated with azithromycin use in this patient population.
“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,” the researchers wrote. “This corresponds to a net benefit of around seven deaths averted for one nonfatal myocardial infarction induced.”
Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.
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