Azitromicina, Ensayo Clinico

The

n e w e ng l a n d j o u r na l

of

m e dic i n e

original article

Azithromycin and the Risk of Cardiovascular Death
Wayne A. Ray, Ph.D., Katherine T. Murray, M.D., Kathi Hall,B.S., Patrick G. Arbogast, Ph.D., and C. Michael Stein, M.B., Ch.B.

A BS T R AC T
BACKGROUND

Although several macrolide antibiotics are proarrhythmic and associated with an increased risk ofsudden cardiac death, azithromycin is thought to have minimal cardiotoxicity. However, published reports of arrhythmias suggest that azithromycin may increase the risk of cardiovascular death.
METHODSWe studied a Tennessee Medicaid cohort designed to detect an increased risk of death related to short-term cardiac effects of medication, excluding patients with serious noncardiovascular illness andperson-time during and shortly after hospitalization. The cohort included patients who took azithromycin (347,795 prescriptions), propensity-score–matched persons who took no antibiotics (1,391,180control periods), and patients who took amoxicillin (1,348,672 prescriptions), ciprofloxacin (264,626 prescriptions), or levofloxacin (193,906 prescriptions).
RESULTS

From the Division ofPharmacoepidemiology, Department of Preventive Medicine (W.A.R., K.H.), the Departments of Medicine and Pharmacology, Divisions of Cardiology (K.T.M.), Rheumatology (C.M.S.), and Clinical Pharmacology (K.T.M.,C.M.S.), and the Department of Biostatistics (P.G.A.), Vanderbilt University School of Medicine; and the Geriatric Research Education and Clinical Center, Nashville Veterans Affairs Medical Center(W.A.R.) — both in Nashville. Address reprint requests to Dr. Ray at the Department of Preventive Medicine, Village at Vanderbilt, Suite 2600, 1501 21st Ave. S., Nashville, TN 37212, or cindy.naron@vanderbilt.edu. N Engl J Med 2012;366:1881-90.
Copyright © 2012 Massachusetts Medical Society.

During 5 days of therapy, patients taking azithromycin, as compared with those who took no antibiotics,...