Presentation Outline ICHP Annual Meeting September 13-15

Azithromycin and CV Death
Azithromycin Vs. Fluoroquinolones
• Azithromycin increased risk for CV death
compared to ciprofloxacin
• HR HR, 3.49; 349 95% CI CI, 132t 1.32 to 926 9.26; P001 P=0.01
• Azithromycin did not increase risk for CV
death compared to levofloxacin
• HR, 1.27; 95% CI, 0.66 to 2.47; P=0.48
N Engl J Med. 2012;366(20):1881-1889.
Azithromycin and CV Death
Overall Conclusion Patients should not stop taking
• Azithromycin
until
resulted
discussing
in
with
small
healthcare
but significant
professional. Prescribers should
increase in risk for CV death
be aware of the potential for QT
– Increase greatest prolongation for those and found arrhythmias to be at highest
CV risk with azithromycin.
• 47 additional CV deaths per 1 million courses
of azithromycin therapy when compared to
amoxicillin
• Also increased risk for overall death, but not
non‐CV death
N Engl J Med. 2012;366(20):1881-1889.
Azithromycin and CV Death
Strengths
• Large cohort observed over
several years
• 2 controls for confounders
• Validity of study
assumptions tested, with
similar results
N Engl J Med. 2012;366(20):1881-1889.
Limitations
• Observational, cannot
observe cause and effect
• Data from only 1 geographic
location
• Difficult to extrapolate to
men, race other than white
• Accuracy of
database/coding
8/30/2012
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