Azithromycin Risk of Cardiovascular Death

[Chemar]

I received the alert in my Journal Watch/Physicians First Watch today:

Azithromycin Associated with Cardiovascular Death

 

The antibiotic azithromycin — which may have proarrhythmic properties — is associated with increased risk for cardiovascular death, according to a retrospective cohort study in the New England Journal of Medicine.

 

The study, in a Medicaid population, included nearly 350,000 azithromycin prescriptions, 1.4 million control periods without antibiotic prescriptions, and 1.8 million prescriptions for other antibiotics, mostly amoxicillin.

 

Azithromycin conferred a nearly threefold increase in risk for CV death and a nearly twofold increase in all-cause mortality during the 5 days of therapy, relative to no treatment. When azithromycin and amoxicillin were compared, there were 47 excess CV deaths per 1 million courses of azithromycin. For patients with the highest CV risk at baseline, there were 245 excess deaths per 1 million azithromycin treatments, compared with amoxicillin.

 

Azithromycin also posed greater risk for CV mortality compared with ciprofloxacin, but not compared with levofloxacin.

 

In HIV and ID Observations, Dr. Paul Sax writes: "If there's a silver lining to this report ... it's that clinicians will stop prescribing azithromycin for conditions that clearly don't need it — which is just about every uncomplicated outpatient respiratory infection. ... Hey, we can dream, can't we?"

 

 

here is the link to the New England Journal of Medicine abstract

http://www.nejm.org/doi/full/10.1056/NEJMoa1003833

 

and the commentary in HIV and ID Observations

http://blogs.jwatch.org/hiv-id-observations/index.php/azithromycin-linked-to-cardiovascular-death-not-a-placebo-after-all/2012/05/16/?q=pfw

[dcmom]

Thanks, Chemar!

[fightingmom]

Great. Now it will be even harder to get.

[EAMom]

I received the alert in my Journal Watch/Physicians First Watch today:

Azithromycin Associated with Cardiovascular Death

 

The antibiotic azithromycin — which may have proarrhythmic properties — is associated with increased risk for cardiovascular death, according to a retrospective cohort study in the New England Journal of Medicine.

 

The study, in a Medicaid population, included nearly 350,000 azithromycin prescriptions, 1.4 million control periods without antibiotic prescriptions, and 1.8 million prescriptions for other antibiotics, mostly amoxicillin.

 

Azithromycin conferred a nearly threefold increase in risk for CV death and a nearly twofold increase in all-cause mortality during the 5 days of therapy, relative to no treatment. When azithromycin and amoxicillin were compared, there were 47 excess CV deaths per 1 million courses of azithromycin. For patients with the highest CV risk at baseline, there were 245 excess deaths per 1 million azithromycin treatments, compared with amoxicillin.

 

Azithromycin also posed greater risk for CV mortality compared with ciprofloxacin, but not compared with levofloxacin.

 

In HIV and ID Observations, Dr. Paul Sax writes: "If there's a silver lining to this report ... it's that clinicians will stop prescribing azithromycin for conditions that clearly don't need it — which is just about every uncomplicated outpatient respiratory infection. ... Hey, we can dream, can't we?"

 

 

here is the link to the New England Journal of Medicine abstract

http://www.nejm.org/doi/full/10.1056/NEJMoa1003833

 

and the commentary in HIV and ID Observations

http://blogs.jwatch.org/hiv-id-observations/index.php/azithromycin-linked-to-cardiovascular-death-not-a-placebo-after-all/2012/05/16/?q=pfw

 

It's interesting that the Sax guy talks about indiscriminant antibiotic use...sorry, but all this arrogant talk about indiscriminant antibiotic use just makes my blood boil, b/c this is the same line of thinking that makes it so hard for PANDAS kids to get antibiotics. And, one reason why doctors don't want to treat strep carriers (or even bother to test, "they might just be a carrier"). IMHO it is also part of the reason for the backlash in the mainstream medical community re chronic Lyme.

 

It's REALLY hard for people to get antibiotics...psych. drugs on the other hand, are handed out like candy.

Edited May 17, 2012 by EAMom

[Chemar]

I think it is important not to miss the wood for the trees here....

 

a research study was conducted and published in the NEJM related to statistics (and they seem to have had large samples) of CV risk with azith being higher than amox

 

that Dr Sax made an annoying remark, yes..... but the actual study is what should be noted.

[tpotter]

I don't think I really wanted to know this But, I guess I really needed to.

[philamom]

I don't think I really wanted to know this But, I guess I really needed to.

I agree. Thanks for sharing, Chemar!

 

Now it really pisses me off that the doctors didn't treat my daughter correctly in the first place, putting me in a position to treat with stronger antibiotics to manage a chronic condition.

[JAG10]

While "Medicaid" population is sited, there is no age range provided within the text and the graphs are miniscule. However, the researchers are from "Geriatric Research Education" and the VA.....no mention of any pediatrics.

 

 

From the Division of Pharmacoepidemiology, Department of Preventive Medicine (W.A.R., K.H.), the Departments of Medicine and Pharmacology, Divisions of Cardiology (K.T.M.), Rheumatology (C.M.S.), and Clinical Pharmacology (K.T.M., C.M.S.), and the Department of Biostatistics (P.G.A.), Vanderbilt University School of Medicine; and the Geriatric Research Education and Clinical Center, Nashville Veterans Affairs Medical Center (W.A.R.) — both in Nashville.

[Chemar]

As far as I know, people who are over 65 are not on Medicaid, even when they qualify for Medicaid.....they are Medicare when they are seniors.

It doesn't sound as tho there were any pediatric patients in the study.

[EAMom]

I don't think I really wanted to know this But, I guess I really needed to.

I agree. Thanks for sharing, Chemar!

 

Now it really pisses me off that the doctors didn't treat my daughter correctly in the first place, putting me in a position to treat with stronger antibiotics to manage a chronic condition.

 

YEs...I don't believe my dd would have chronic PANDAS (or any PANDAS) if they had bothered to swab her/check her for strep when I brought her in for FEVERs when she was a toddler/preschooler. All fevers were presumed viral. I don't want to think about how many untreated strep infections she had.

[philamom]

I don't think I really wanted to know this But, I guess I really needed to.

I agree. Thanks for sharing, Chemar!

 

Now it really pisses me off that the doctors didn't treat my daughter correctly in the first place, putting me in a position to treat with stronger antibiotics to manage a chronic condition.

 

YEs...I don't believe my dd would have chronic PANDAS (or any PANDAS) if they had bothered to swab her/check her for strep when I brought her in for FEVERs when she was a toddler/preschooler. All fevers were presumed viral. I don't want to think about how many untreated strep infections she had.

One of the doctors I took my daughter to see for PANDAS when younger said not possible because her throat culture was negative. Yet he treated her for impetego a month prior. I learned HERE years later that impetego is strep related! Crazy!!

 

Saw another doctor in the same practice who dismissed my daughter's tick bite because there was no bulls eye rash, even though she had joint pain. A month later she came down with flu-like symptoms -no connection was ever made!

 

Sorry to rant.

Edited May 17, 2012 by philamom

[JAG10]

The elderly definitely qualify for medicaid as do veterans. Medicaid is what pays for nursing homes for those who cannot pay privately. Medicare only pays for "short term" rehab like after a stroke.

[Chemar]

Jag

I know for a fact that some people who turn 65 have their Medicaid converted to Medicare as I have a relative in that situation

 

honestly, I am not sure why there is this "shoot the messenger" attitude here. If my child was on a medication that had even the slightest risk of such a potentially serious side effect, I would at least want to know about it and do further research/enquiries.

It may have no relevance to children....but then again, it may.

I posted because it MAY, and I care.

[JAG10]

Oh goodness, Chemar- NO! Guns down, no messenger shooting here.

 

My point was to view this study with a frame of reference and that doesn't appear to be a pediatric reference.

 

As far as your relative's situation, I'm sure you are quite certain of the details. I am quite certain that the elderly can have both Medicare and Medicaid. Medicaid is for the poor. Medicare is for those who pay into it and are getting a service that is reimbursed by Medicare like acute rehab and the number of days per year covered are limited. When those elderly who are poor enough no longer receive a skilled service that qualifies for Medicare coverage, Medicaid then covers their skilled care in nursing homes. I am positive that not all Medicaid participants convert to solely medicare at age 65. It is complicated though.

[Chemar]

My relative is poor, disabled and was on Medicaid

When he turned 65, his medicaid was converted to Medicare.

 

I really don't want to take this off topic

I received info that I felt needed to be posted here.

It can be taken or left.