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Azithromycin, Levofloxacin Linked to Increased Risks for Arrhythmia and Mortality Compared with Amoxicillin — Physician’s First Watch

Medical News |
March 11, 2014

Azithromycin, Levofloxacin Linked to Increased Risks for Arrhythmia and Mortality Compared with Amoxicillin

By Amy Orciari Herman

Azithromycin and levofloxacin carry higher arrhythmia and mortality risks than amoxicillin, according to an observational study in the Annals of Family Medicine. The FDA issued a cardiac warning on azithromycin in March 2013.

Researchers studied nearly 1.8 million U.S. veterans (mean age, 57) who received outpatient prescriptions for one of the three antibiotics from 1999 to 2012. On weighted analysis, the numbers of deaths by day 5 of treatment per million antibiotics dispensed were 154 for amoxicillin, 228 for azithromycin, and 384 for levofloxacin. Patients receiving azithromycin had roughly a 50% increased risk for death and an 80% increased risk for serious arrhythmia, compared with those on amoxicillin. Risk increases were even greater for levofloxacin.

The researchers conclude: "There are usually multiple antibiotic choices available for older patients, especially those with cardiac comorbidities; physicians may consider prescribing medications other than azithromycin and levofloxacin."

Reader Comments (4)

Nikola Rosic, MD Physician, Pharmacology/Pharmacy, Kragujevac, Serbia

I heard about cardiotoxicity levofloxacin and azythromycin but didn't read article about that!

Pedro Vargas Physician, Pediatric Subspecialty

Was there a significant difference when compared populations with and without cardiac comorbidities?

Thomas Kline MD
Competing Interests: practicing physician of 35 years, took a slice of pizza 25 years ago from an Abbott salesman.

Good grief. This is classical retrospective, selection bias
pseudo-science. So, who would get levofloxacin verus who
would get amoxicillin? Maybe SICKER patients?

SICKER patients die more, right?

Then to make a general recommendation based on this study is likely to kill more people than the antibiotic side effects by
not having proper coverage (like H. influenza for example
resistant to amoxicillin)

Dr. V Kantariya MD Physician, Family Medicine/General Practice

The Beers, STOP and START criteria can help identify medication causing ADE in older adults, but they are not perfect. Systematic Reviews of Adverse Events don`t report Harms Well, ADE are common just after hospitalisation..During 2007 a total of 38371drug-induced deaths occured in US. CHOOSING WISELY!

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