Azithromycin has been associated with increased cardiovascular events, but a new study suggests that it may be safe for treating older patients with pneumonia. In a study from the Veterans Administration acute care hospital system, nearly 32,000 adults ≥ 65 years who were hospitalized for pneumonia and treated with azithromycin were matched with 32,000 who were on a “guideline-concordant regimen” that did not include azithromycin. Outcomes included 30- and 90-day all-cause mortality and heart-related mortality as well as cardiac events. Mortality at 90 days was significantly lower in the group treated with azithromycin (17.4% vs 22.3%, odds ratio, 0.73; 95% CI, 0.70-0.76). There was a higher rate of MI, but no increase in overall cardiac events with azithromycin. The authors conclude that among older patients hospitalized with pneumonia, a treatment regimen that includes azithromycin was associated with a lower 90-day mortality and a smaller increased risk of MI (JAMA 2014;311:2199-2208).
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