Advertisement  

November 18, 2015
Macrolides Linked to Slightly Increased Risk of
Sudden Cardiac Death

Guangzhou, China—A small but statistically significant increased risk of sudden cardiac death occurs with the use of macrolides, according to a meta-analysis involving more than 20 million patients.

The review, published recently in the Journal of the American College of Cardiology, looked at 33 studies, conducted between 1996 and 2015, comparing patients treated with macrolides—commonly used for pneumonia, bronchitis and some sexually transmitted diseases—to similar patients treated with other antibiotics or with no antibiotic therapy.

Chinese researchers from the First Affiliated Hospital at Sun Yat-Sen University found an average of 80 cases of ventricular tachyarrhythmias per million treatment courses in patients who were not taking macrolides. Results indicate that current use of macrolides led to an additional 118 ventricular tachyarrhythmias or related sudden cardiac deaths per million treatment courses, as well as 36 additional sudden cardiac deaths from causes other than ventricular tachyarrhythmia and 38 additional cardiovascular deaths per million treatment courses.

The commonly used macrolides azithromycin, clarithromycin, and erythromycin were all associated with increased risk of sudden cardiac death or ventricular tachyarrhythmias, with azithromycin and clarithromycin also associated with increased risk of cardiovascular death. Only clarithromycin was associated with increased risk of all-cause mortality, according to the study.

The increased cardiovascular risk was not associated with past use of macrolides or with other antibiotics, the report notes. In addition, according to study authors, the rates of all-cause death did not increase, possibly because macrolide’s anti-infection benefit might have offset the small increased risk of cardiac death.

“The absolute risks of sudden cardiac death and cardiac death are small, so it should likely have limited effect on prescribing practice,” explained co-author Su-Hua Wu, MD, PhD. “However, given that macrolides are one of the most commonly used antibiotic groups and millions of patients are prescribed these drugs annually, the total number of sudden cardiac deaths or ventricular tachyarrhythmias and cardiac deaths may not be negligible.”

The risks were put into perspective in an accompanying editorial from Sami Viskin, MD, of the Tel Aviv Medical Center and Sackler School of Medicine at Tel Aviv University in Israel. Based on the data, 1 in 8,500 patients treated with a macrolide antibiotic could develop a serious arrhythmic event, and 1 in 30,000 patients treated might die from the treatment, Viskin notes.

While Wu said that the heart safety of each macrolide needs to be better understood to help guide clinical treatment decisions, Viskin called for “a consensus paper on how to deal with these hot potatoes.”

“Today, when antimicrobial resistance represents a major threat to global health and new treatment options are frighteningly few, losing an entire class of antibiotics would represent a major setback in the fight against infections,” Viskin emphasizes. “Furthermore, it takes years to fully understand the consequences of a drug's disappearance.”



Connect With U.S. Pharmacist
USP Google AppUSP Itunes App