Use of azithromycin and risk of ventricular arrhythmia

May 9, 2017 at 3:34 pm

Canadian Medical Journal Association April 18, 2017 V.189 N.15

Gianluca Trifirò, Maria de Ridder, Janet Sultana, Alessandro Oteri, Peter Rijnbeek, Serena Pecchioli, Giampiero Mazzaglia, Irene Bezemer, Edeltraut Garbe, Tania Schink, Elisabetta Poluzzi, Trine Frøslev, Mariam Molokhia, Igor Diemberger, and Miriam C.J.M. Sturkenboom

BACKGROUND

There are conflicting findings from observational studies of the arrhythrogenic potential of azithromycin. Our aim was to quantify the association between azithromycin use and the risk of ventricular arrhythmia.

METHODS

We conducted a nested case–control study within a cohort of new antibiotic users identified from a network of 7 population-based health care databases in Denmark, Germany, Italy, the Netherlands and the United Kingdom for the period 1997–2010. Up to 100 controls per case were selected and matched by age, sex and database. Recency of antibiotic use and type of drug (azithromycin was the exposure of interest) at the index date (occurrence of ventricular arrhythmia) were identified. We estimated the odds of ventricular arrhythmia associated with current azithromycin use relative to current amoxicillin use or nonuse of antibiotics (≥ 365 d without antibiotic exposure) using conditional logistic regression, adjusting for confounders.

RESULTS

We identified 14 040 688 new antibiotic users who met the inclusion criteria. Ventricular arrhythmia developed in 12 874, of whom 30 were current azithromycin users. The mean age of the cases and controls was 63 years, and two-thirds were male. In the pooled data analyses across databases, azithromycin use was associated with an increased risk of ventricular arrhythmia relative to nonuse of antibiotics (adjusted odds ratio [OR] 1.97, 95% confidence interval [CI] 1.35–2.86). This increased risk disappeared when current amoxicillin use was the comparator (adjusted OR 0.90, 95% CI 0.48–1.71). Database-specific estimates and meta-analysis confirmed results from the pooled data analysis.

INTERPRETATION

Current azithromycin use was associated with an increased risk of ventricular arrhythmia when compared with nonuse of antibiotics, but not when compared with current amoxicillin use. The decreased risk with an active comparator suggests significant confounding by indication.

PDF

http://www.cmaj.ca/content/189/15/E560.full.pdf+html

Advertisements

Entry filed under: Antimicrobianos, REPORTS, Update.

Synovial Fluid Cell Count for Diagnosis of Chronic Periprosthetic Hip Infection. Guidelines – Recommendations on hepatitis C screening for adults


Calendar

May 2017
M T W T F S S
« Apr    
1234567
891011121314
15161718192021
22232425262728
293031  

Most Recent Posts


%d bloggers like this: