![]() 6 Consequently, the role of azithromycin in each case is unclear. 7, 8 Moreover, despite the widespread use of azithromycin, reports of torsades de pointes in patients taking this drug are exceedingly rare, and almost all of them involve patients with other risk factors for QT prolongation. Although azithromycin can cause QT prolongation, 6 it does so to a lesser extent than either erythromycin or clarithromycin. 2 A prolonged QT interval is a major risk factor for torsades de pointes, the same potentially lethal arrhythmia responsible for the disappearance from pharmacy shelves of terfenadine, cisapride, astemizole and grepafloxacin. The 2012 study was predicated on the observation that azithromycin can prolong the QT interval. 5 The authors argued that the new study did not exclude an increased cardiovascular risk because it involved patients who were relatively healthy. 3 This study garnered considerably fewer headlines, but was accompanied by a commentary from officials at the FDA, 4 which had only a few months earlier strengthened its warnings about the cardiac risk of azithromycin. 2 The publication spawned extensive media coverage, with headlines that grew even more disquieting following a review of the available data by the US Food and Drug Administration (FDA).Ī year later, NEJM published a study from Denmark involving 1.1 million treatment courses of azithromycin, which found no increased risk of cardiovascular death relative to penicillin V (rate ratio 0.93, 95% CI 0.56–1.55). 2 The study found that azithromycin was associated with an increased risk of cardiovascular death relative to amoxicillin (odds ratio 2.49, 95% confidence interval 1.38–4.50). In 2012, the New England Journal of Medicine ( NEJM) published a study involving the health records of Medicaid recipients in Tennessee. Subsequent studies suggested these concerns may have been overstated. 1 It has also been considered relatively safe however, in 2012, a widely publicized study raised concerns about its cardiovascular safety. The drug has become popular because of its broad spectrum of antimicrobial activity, convenience of dosing and favourable drug interaction profile relative to its predecessors erythromycin and clarithromycin. More than 50 million prescriptions are issued in the United States annually, typically for respiratory tract and sexually transmitted infections. Azithromycin is one of the most widely used antibiotics in clinical practice. ![]()
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