Cardiac Events Linked to Macrolide Antibiotics

Macrolide antibiotic use is associated with an increased risk of sudden cardiac death (SCD) and ventricular tachyarrhythmia (VTA), according to a new study.

Researchers at the First Affiliated Hospital of Sun Yat-Sen University (SYSU; Guangzhou, China) conducted a meta-analysis of studies to examine the link between use of oral macrolide antibiotics and risk of SCD, VTA, cardiovascular death, and death from any cause. The researchers performed a search of published reports by using MEDLINE and EMBASE with no restrictions. In all, 33 studies involving 20,779,963 participants met study criteria.

The results showed that patients taking macrolides experienced a 2.5 fold risk of developing SCD or VTA, and a 31% increased risk of cardiovascular death; no association was found between macrolides use and all-cause death or any cardiovascular events. The relative risk (RR) associated with SCD or VTA was 3.40 for azithromycin, 2.16 for clarithromycin, and 3.61 for erythromycin, respectively. The RR for cardiovascular death was 1.54 for azithromycin and 1.48 for clarithromycin; no association was noted between roxithromycin and adverse cardiac outcomes. The study was published in the November 2015 issue of the Journal of the American College of Cardiology (JACC).

“Although currently it is still too early to conclude that the observed high-risk is due to drug effect, related to the type of infectious disease, or underlying comorbidities,” said study coauthor Chia-Hsuin Chang, MD. “It is suggested that physicians should pay more attention to their potential cardiac toxicity, avoid unnecessary use of macrolides, and shift to betalactam antibiotics if possible.”

Macrolides are protein synthesis inhibitors whose activity stems from the presence of a macrolide ring. They are used to treat infections caused by Gram-positive and limited Gram-negative bacteria, and some respiratory tract and soft-tissue infections. Since the antimicrobial spectrum of macrolides is slightly wider than that of penicillin, they are therefore a common substitute in patients with a penicillin allergy.

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