快樂小藥師 Im pharmacist nichts glücklich

Macrolides were associated with more myocardial infarctions but lower mortality.

The Infectious Diseases Society of America and the American Thoracic Society recommend treating patients with community-acquired pneumonia with either a fluoroquinolone or combination β-lactam/macrolide (Clin Infect Dis 2007; 44:Suppl 2:S27) [Free full-text Clin Infect Dis article PDF]. One recent observational study suggested excess cardiovascular-related mortality with azithromycin use, and another did not, but neither of those studies focused specifically on patients with community-acquired pneumonia (NEJM JW Gen Med May 1 2013 [Free full-text NEJM article PDF | PubMed® abstract] and NEJM JW Gen Med May 22 2012 [Free full-text NEJM article PDF at PubMed® Central | PubMed® abstract]). In this study, investigators retrospectively examined data on 63,726 patients (mean age, 78; 98% men, most with multiple comorbidities) from the Veterans Affairs system who were hospitalized with pneumonia.

Based on propensity-score analysis (in which azithromycin recipients and nonrecipients were otherwise closely matched on many clinical characteristics), 90-day mortality was lower in the patients who received azithromycin (17.4% vs. 22.3%), although the incidence of myocardial infarction was higher (5.1% vs. 4.4%). No difference between groups was noted for arrhythmia or heart failure. The number needed to treat for a lower 90-day mortality risk was 21, whereas the number needed to harm (i.e., myocardial infarction) was 144.

COMMENT

Although this was not a randomized, controlled study, this large, population-based cohort analysis supports continued use of azithromycin as a first-line agent (in conjunction with a β-lactam) for patients hospitalized with community-acquired pneumonia. The authors speculate that the beneficial effects of azithromycin might reflect not only its antimicrobial, but also its anti-inflammatory, properties.

Patricia Anne Kritek, MD, EdM reviewing Mortensen EM et al. JAMA 2014 Jun 4.

CITATION(S):

Mortensen EM et al. Association of azithromycin with mortality and cardiovascular events among older patients hospitalized with pneumonia. JAMA2014 Jun 4; 311:2199.
[PubMed® abstract]