WEDNESDAY, June 17, 2020 (HealthDay News) — Outpatient azithromycin use is associated with an increased risk for cardiovascular and noncardiovascular mortality, according to a study published online June 17 in JAMA Network Open.

Jonathan G. Zaroff, M.D., from Kaiser Permanente Northern California in Oakland, and colleagues estimated the relative and absolute risks of cardiovascular and sudden cardiac death after an outpatient azithromycin prescription compared with amoxicillin using data from two large, diverse, community-based integrated care delivery systems. Data were included for 7,824,681 antibiotic exposures (22.2 and 77.8 percent azithromycin and amoxicillin, respectively) among 2,929,008 unique individuals.

The researchers found that azithromycin was associated with a significantly increased risk for cardiovascular death within five days of exposure (hazard ratio, 1.82; 95 percent confidence interval, 1.23 to 2.67), but not sudden cardiac death (hazard ratio, 1.59; 95 percent confidence interval, 0.90 to 2.81). At six to 10 days after exposure, there were no increases in risk observed. In patients within the top decile of cardiovascular risk, results were similar (hazard ratio, 1.71; 95 percent confidence interval, 1.06 to 2.76). Within five days of exposure, azithromycin also was associated with an increased risk for noncardiovascular death (hazard ratio, 2.17; 95 percent confidence interval, 1.44 to 3.26) and all-cause mortality (hazard ratio, 2.00; 95 percent confidence interval, 1.51 to 2.63).

“Although these analyses cannot establish causality, prescribers should be aware of this potential association,” the authors write.

Two authors disclosed financial ties to the pharmaceutical industry; the study was funded by Pfizer.

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