Azithromycin for pneumonia: Lower death risk, higher heart attack risk

A significantly lower death risk but a slightly increased risk of heart attack face older adults whose pneumonia is treated with azithromycin instead of other antibiotics. That’s according to a study of almost 65,000 older adults that appears in the June 4 issue of JAMA.

Clinical practice guidelines recommend combination therapy with macrolides (a class of antibiotics), including azithromycin, as first-line therapy for those hospitalized with pneumonia. Recent research, however, suggests that azithromycin may be associated with increased cardiovascular events, according to background information in the article.

Eric M. Mortensen, MD, MSc, of the Veterans Affairs (VA) North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and colleagues assessed the association of azithromycin use and outcomes within 90 days of hospital admission, including cardiovascular events (heart failure, heart attack and cardiac arrhythmias) and death, for those aged 65 or more years who were hospitalized with pneumonia at any VA acute care hospital from fiscal years 2002 through 2012. Their final analysis included 31,863 older adults who received azithromycin and 31,863 matched individuals who did not receive azithromycin but did receive some other acceptable therapy.

The researchers found that 90-day mortality was significantly lower in those who received azithromycin (17.4 percent, versus 22.3 percent). An increased odds of heart attack (5.1 percent versus 4.4 percent) also existed, but not any cardiac event (43.0 percent versus 42.7 percent), cardiac arrhythmias (25.8 percent versus 26.0 percent) or heart failure (26.3 percent versus 26.2 percent).

An analysis conducted by the authors found that seven deaths were prevented for every heart attack induced by the use of azithromycin. “These findings are consistent with a net benefit associated with azithromycin use in patients hospitalized for pneumonia,” they wrote.