Azithromycin is generally considered to be an antibiotic associated with a low risk of important adverse effects, reflecting its frequent use in diverse outpatient disorders such as sinusitis, otitis, and bronchitis. It has been recently recognized that azithromycin is uncommonly associated with QT prolongation, which could — at least in theory — lead to cardiac toxicity. Contradicting that belief are at least two large data sets that failed to identify any cardiovascular risk signal.
Mortensen et al performed a retrospective cohort study in older patients (≥ 65 years of age; mean age = 77.8 years) who had been hospitalized with pneumonia to compare outcomes in patients who had been treated with azithromycin (n = 31,863) vs other antibiotics (n = 31,863).
Ninety-day mortality was found to be lower in the group who had been treated with azithromycin than in the group who had been treated with comparator antibiotics (odds ratio [OR] = 0.73). Even though there was a small relative increased risk of myocardial infarction (OR = 1.17; absolute event rate increase = 0.7%) in the azithromycin group, this was not sufficient to counteract the overall mortality advantage.
Because the population from which these data were drawn included only Veterans Administration patients, subjects were almost exclusively male (98.2%). Nonetheless, no differences in outcomes were discerned between genders (female study population, n = 1134).
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