0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Association of Azithromycin With Mortality and Cardiovascular Events Among Older Patients Hospitalized With Pneumonia

Eric M. Mortensen, MD, MSc1,2; Ethan A. Halm, MD, MPH2; Mary Jo Pugh, PhD4,5; Laurel A. Copeland, PhD7; Mark Metersky, MD8; Michael J. Fine, MD, MSc6; Christopher S. Johnson, MPH1,2; Carlos A. Alvarez, PharmD, MSc1,2,3; Christopher R. Frei, PharmD, MSc5,9; Chester Good, MD6; Marcos I. Restrepo, MD, MSc4,5; John R. Downs, MD4,5; Antonio Anzueto, MD4,5
[+] Author Affiliations
1VA North Texas Health Care System, Dallas
2University of Texas Southwestern Medical Center, Dallas
3Texas Tech University Health Sciences Center, Dallas
4VERDICT Research Program, South Texas Veterans Health Care System, San Antonio
5University of Texas Health Science Center at San Antonio
6VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, Pennsylvania
7Center for Applied Health Research, Central Texas Veterans Health Care System jointly with Scott and White Healthcare, Temple, Texas
8University of Connecticut Medical Center, Farmington
9University of Texas at Austin
JAMA. 2014;311(21):2199-2208. doi:10.1001/jama.2014.4304.
Text Size: A A A
Published online

Importance  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.

Objective  To examine the association of azithromycin use with all-cause mortality and cardiovascular events for patients hospitalized with pneumonia.

Design  Retrospective cohort study comparing older patients hospitalized with pneumonia from fiscal years 2002 through 2012 prescribed azithromycin therapy and patients receiving other guideline-concordant antibiotic therapy.

Setting  This study was conducted using national Department of Veterans Affairs administrative data of patients hospitalized at any Veterans Administration acute care hospital.

Participants  Patients were included if they were aged 65 years or older, were hospitalized with pneumonia, and received antibiotic therapy concordant with national clinical practice guidelines.

Main Outcomes and Measures  Outcomes included 30- and 90-day all-cause mortality and 90-day cardiac arrhythmias, heart failure, myocardial infarction, and any cardiac event. Propensity score matching was used to control for the possible effects of known confounders with conditional logistic regression.

Results  Of 73 690 patients from 118 hospitals identified, propensity-matched groups were composed of 31 863 patients exposed to azithromycin and 31 863 matched patients who were not exposed. There were no significant differences in potential confounders between groups after matching. Ninety-day mortality was significantly lower in those who received azithromycin (exposed, 17.4%, vs unexposed, 22.3%; odds ratio [OR], 0.73; 95% CI, 0.70-0.76). However, we found significantly increased odds of myocardial infarction (5.1% vs 4.4%; OR, 1.17; 95% CI, 1.08-1.25) but not any cardiac event (43.0% vs 42.7%; OR, 1.01; 95% CI, 0.98-1.05), cardiac arrhythmias (25.8% vs 26.0%; OR, 0.99; 95% CI, 0.95-1.02), or heart failure (26.3% vs 26.2%; OR, 1.01; 95% CI, 0.97-1.04).

Conclusions and Relevance  Among older patients hospitalized with pneumonia, treatment that included azithromycin compared with other antibiotics was associated with a lower risk of 90-day mortality and a smaller increased risk of myocardial infarction. These findings are consistent with a net benefit associated with azithromycin use.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Place holder to copy figure label and caption
Figure 1.
Survival Curves by Azithromycin Use vs Nonuse

Not included in this analysis were 125 patients who died on the same day as admission.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Time to First Cardiac Event by Azithromycin Use vs Nonuse

Cardiovascular events were myocardial infarction, heart failure, and cardiac arrhythmia. Not included in this analysis were 176 patients who had a cardiovascular event on the same day as admission.

Graphic Jump Location

Tables

References

Letters

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Related Multimedia

Author Interview

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();