Pneumonia patients treated with azithromycin had lower risk of death, small increased risk of heart attack

In older adults hospitalized with pneumonia, treatment that included azithromycin compared with other antibiotics was associated with a significantly lower risk of death and a slightly increased risk of heart attack, according to a study in the June 4 issue of JAMA.

In patients aged 65 years and older who were hospitalized with pneumonia at any Veterans Administration acute care hospital from 2002 through 2012, researchers looked at the association of azithromycin use and outcomes within 90 days of hospital admission, including cardiovascular events and death.

The final analysis included 31,863 patients who received azithromycin and 31,863 matched patients who did not, but some other guideline-concordant therapy. The researchers found that 90-day mortality was significantly lower in those who received azithromycin (17.4% vs 22.3%). There was also an increased odds of heart attack (5.1% vs 4.4%), but not any cardiac event (43.0% vs 42.7%), cardiac arrhythmias (25.8% vs 26.0%), or heart failure (26.3% vs 26.2%), according to a press release.

“Although our findings partially support the study by Ray et al. that demonstrated increased cardiac death for outpatients overall our study confirms the safety and efficacy of azithromycin therapy for older patients hospitalized with pneumonia,” said Eric M. Mortensen, MD, MSc, of the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas. “Therefore there are 2 important points: 1) azithromycin should not be used in those with no appropriate indications for antibiotics and 2) azithromycin is safe when used as part of guideline-concordant antibiotic therapy for those with pneumonia.”  

Together, pneumonia and influenza are the eighth leading cause of death and the leading causes of infectious death in the United States. Although clinical practice guidelines recommend combination therapy with macrolides, including azithromycin, as first-line therapy for patients hospitalized with pneumonia, recent research suggests that azithromycin may be associated with increased cardiovascular events.