Macrolide antibiotics and the risk of ventricular arrhythmia in older adults

Published: February 22, 2016
Category: Bibliography > Papers
Authors: Dixon SN, Garg AX, Hackam DG, Jandoc R, McArthur E, Nash DM, Trac MH
Countries: Canada
Language: null
Types: Population Health
Settings: Hospital, PCP


Western University, London, ON, Canada; London Health Sciences Centre, London, ON, Canada; Institute for Clinical Evaluative Sciences (ICES) Western, London, ON, Canada

BACKGROUND: Many respiratory tract infections are treated with macrolide antibiotics. Regulatory agencies warn that these antibiotics increase the risk of ventricular arrhythmia. We examined the 30-day risk of ventricular arrhythmia and all-cause mortality associated with macrolide antibiotics relative to nonmacrolide antibiotics.

METHODS: We conducted a population-based retrospective cohort study involving older adults (age > 65 yr) with a new prescription for an oral macrolide antibiotic (azithromycin, clarithromycin or erythromycin) in Ontario from 2002 to 2013. Our primary outcome was a hospital encounter with ventricular arrhythmia within 30 days after a new prescription. Our secondary outcome was 30-day all-cause mortality. We matched patients 1:1 using propensity scores to patients prescribed nonmacrolide antibiotics (amoxicillin, cefuroxime or levofloxacin). We used conditional logistic regression to measure the association between macrolide exposure and outcomes, and repeated the analysis in 4 subgroups defined by the presence or absence of chronic kidney disease, congestive heart failure, coronary artery disease and concurrent use of a drug known to prolong the QT interval.

RESULTS: Compared with nonmacrolide antibiotics, macrolide antibiotics were not associated with a higher risk of ventricular arrhythmia (0.03% v. 0.03%; relative risk [RR] 1.06, 95% confidence interval [CI] 0.83-1.36) and were associated with a lower risk of all-cause mortality (0.62% v. 0.76%; RR 0.82, 95% CI 0.78-0.86). These associations were similar in all subgroups.

INTERPRETATION: Among older adults, macrolide antibiotics were not associated with a higher 30-day risk of ventricular arrhythmia than nonmacrolide antibiotics. These findings suggest that current warnings from the US Food and Drug

PMID: 26903359

Population Health,Canada,Medications,Age,Prescription Drug Use and Expenditures,Mortality Prediction,Aged,80 and over,Arrhythmias,Cardiac/epidemiology,Arrhythmias,Cardiac/mortality,Azithromycin/adverse effects,Clarithromycin/adverse effects,Cohort Studies,Erythromycin/adverse effects,Gender,Logistic Models,Ontario,Propensity Score,Retrospective Studies,Risk Assessment Risk Factors

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