Azithromycin -- The Heart of the Matter Redux: Preexisting Risks Tell the Tale.

Svanström and colleagues in Copenhagen examined the risk of cardiovascular deaths in association with azithromycin use in a nationwide historical cohort study of Danish adults ages 18 to 64 years. They compared 1,102,050 episodes of azithromycin use with the same number of episodes of no use of antibiotic agents with 1:1 matching using propensity scoring. The risk of cardiovascular mortality with current use of the azalide (but not with past or future use) was increased (rate ratio, 2.85; 95% CI 1.13 to 7.24). There was, however, no excess cardiovascular mortality with current azithromycin use when compared to current use of penicillin V with crude rates of 1.1 and 1.5 per 1000 person years, respectively and, when adjusted, a rate ratio of 0.93 (95% CI, 0.56 to 1.55). Thus, the investigators concluded that "Azithromycin use was not associated with an increased risk of death from cardiovascular causes in a general population of young and middle-aged adults." [ABSTRACT FROM AUTHOR]