 |
|
 |
|
|
Advertisement  |
June 11, 2014
Azithromycin Saves Lives of Older Pneumonia Patients Despite Cardiac Risks
Dallas—For older patients hospitalized with pneumonia, a treatment regimen including azithromycin can be a double-edged sword: The antibiotic slightly increased their risk of heart attack but significantly lowered their risk of death. That’s according to a study of 65,000 older patients treated at Veterans Administration hospitals during a decade ending in 2012. Results of the research, conducted by investigators from the VA North Texas Health Care System and the University of Texas Southwestern Medical Center, were published recently in the Journal of the American Medical Association. The researchers said they embarked on the study because clinical practice guidelines call for the use of azithromycin and other macrolides as first-line therapies for inpatients with pneumonia. Some recent studies, however, have raised alarms about the antibiotics’ risk for increasing cardiovascular events, according to the article’s background. For the study, the cases of 31,863 patients who received azithromycin were compared to another 31,863 patients with similar characteristics who received another guideline-recommended therapy. Overall, 90-day mortality was found to be significantly lower in those who received azithromycin —17.4% versus 22.3%—but odds of having a heart attack were higher—5.1% versus 4.4%. Similar elevated risk was not seen for other cardiac events, 43.0% versus 42.7%; cardiac arrhythmias 25.8% versus 26.0%; or heart failure 26.3% versus 26.2 %. “In this national cohort study of veterans hospitalized with pneumonia, azithromycin use was consistently associated with decreased mortality and a slightly increased odds of myocardial infarction,” the authors write. “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. This corresponds to a net benefit of around seven deaths averted for one nonfatal myocardial infarction induced.” The researchers speculate on why that would be the case. “This study's results raise the question: why would azithromycin be associated with a mild increased odds of cardiac events but decreased odds of mortality,” they ask. “The beneficial effects of azithromycin, and of macrolides in general, as compared with other guideline-concordant antibiotic regimens for pneumonia may be due less to their antimicrobial propensities but more to their effect on immune function. Previous studies have demonstrated that macrolides have significant anti-inflammatory effects.”
|
U.S. Pharmacist Social Connect
 |
|
