Azithromycin is one of the most widely used antibiotics
in the United States. In 2011 more than
40 million Americans received a prescription for azithromycin (Zithromax;
Z-pak; Zmax). Recently, the Food and
Drug Administration distributed a drug safety announcement regarding the risk
of azithromycin in causing fatal heart arrhythmias (irregular heart beat). Should we now stop using azithromycin?
Here's how this drug safety warning came about. Last year researchers reviewed the electronic records
of Medicaid patients in Tennessee. They
found that persons receiving a short course of azithromycin were more likely to
suffer death from cardiovascular disease, especially sudden death thought due
to heart arrhythmia, than persons not receiving antibiotics or receiving an
alternative antibiotic, amoxicillin. If
you were a person with no special risk for cardiovascular disease, then the
increased risk of dying while taking azithromycin was approximately 1 in
111,000. If you had serious underlying
cardiovascular disease or a tendency to develop heart irregularity, the excess
risk of dying while taking azithromycin was 1 in 4,000. To put this in perspective, your risk of
dying from a bolt of lightning is estimated at 1 in 84,000, and your risk of
dying in an automobile accident is estimated at 1 in 100.
There
are two classes of antibiotics that are known to predispose to irregular heart
rhythms. These are the family of
antibiotics called macrolides (including azithromycin, clarithromycin [Biaxin],
and erythromycin) and fluoroquinolones (including ciprofloxacin [Cipro],
levofloxacin [Levaquin], and moxifloxacin [Avelox]). The study cited above found that the risk of
cardiovascular death when taking levofloxacin was the same as when taking
azithromycin. It also found that the risk of death from
cardiovascular disease did not persist after the course of antibiotic.
Our take on this evidence?
1. The evidence suggesting that azithromycin
can stimulate fatal heart arrhythmias is compelling and believable.
2. Will
we continue to prescribe azithromycin for our otherwise healthy patients and
family members for bacterial respiratory tract infections? Yes.
Antibiotics remain among the relatively few drugs in our medical toolbox
that can cure disease.
3. People
who should avoid azithromycin (and other macrolide antibiotics) and
levofloxacin (and other fluoroquinolone antibiotics) are those with a known
tendency to a particular type of irregular heart rhythm of the ventricle
(ventricular arrhythmia) caused by slow electrical repolarization of the heart
muscle, manifesting as prolongation of the QT interval on
electrocardiogram. Your doctor will know
if you have “prolonged QT syndrome” or are taking other medications that might
cause a prolonged QT interval, especially heart medicines such as dofetilide,
amiodarone, or sotalol. A very low blood
level of potassium or an abnormally slow heart rate might also put you at risk
for this type of heart arrhythmia.
4. Is
this evidence one more reason that otherwise healthy people with viral head and
chest colds should take symptomatic treatment (such as acetaminophen [Tylenol],
chicken soup, and tea with honey) rather than unnecessary and unhelpful
antibiotics? Definitely yes.
If you can take care of yourself, asthma isn’t cause for alarm. Here are some ways to prevent future episodes.
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ReplyDeleteAzithromycin generally should not be taken at regular basis as it not only affects the heart but also may lead to kidney failure if taken in much amount.So it's better to take it under doctor's prescription.
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Very informative, Thanks for sharing!
ReplyDeleteGreat post, I agree with your evidence. It's better to just not take azithromycin. Thanks for sharing!
ReplyDeleteAzithromycin is a macrolide antibiotic used to treat different types of bacterial infections, which include skin infections, sinus infections, respiratory infections, throat infections, ear infections, and pneumonia. It is also used to treat sexually transmitted diseases, including gonorrhea and chlamydia. This medicine fights bacteria in the body.
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