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Outcomes for older adults with pneumonia who receive treatment including azithromycin

Date:
June 3, 2014
Source:
The JAMA Network Journals
Summary:
Treatment for pneumonia that included azithromycin compared with other antibiotics was associated with a significantly lower risk of death and a slightly increased risk of heart attack, according to a study that included nearly 65,000 hospitalized older patients. Pneumonia and influenza together are the eighth leading cause of death and the leading causes of infectious death in the United States.

In a study that included nearly 65,000 older patients hospitalized with pneumonia, treatment that included azithromycin compared with other antibiotics was associated with a significantly lower risk of death and a slightly increased risk of heart attack, according to a study in the June 4 issue of JAMA.

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Pneumonia and influenza together are the eighth leading cause of death and the leading causes of infectious death in the United States. Although clinical practice guidelines recommend combination therapy with macrolides (a class of antibiotics), including azithromycin, as first-line therapy for patients hospitalized with pneumonia, recent research suggests that azithromycin may be associated with increased cardiovascular events, according to background information in the article.

Eric M. Mortensen, M.D., M.Sc., of the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and colleagues assessed the association of azithromycin use and outcomes within 90 days of hospital admission, including cardiovascular events (heart failure, heart attack, cardiac arrhythmias) and death, for patients 65 years and older who were hospitalized with pneumonia at any Veterans Administration acute care hospital from fiscal years 2002 through 2012.

The final analysis included 31,863 patients who received azithromycin and 31,863 matched patients who did not, but some other guideline-concordant therapy. The researchers found that 90-day mortality was significantly lower in those who received azithromycin (17.4 percent, vs 22.3 percent). There was also an increased odds of heart attack (5.1 percent vs 4.4 percent), but not any cardiac event (43.0 percent vs 42.7 percent), cardiac arrhythmias (25.8 percent vs 26.0 percent), or heart failure (26.3 percent vs 26.2 percent).

"In this national cohort study of veterans hospitalized with pneumonia, azithromycin use was consistently associated with decreased mortality and a slightly increased odds of myocardial infarction," the authors write. "To put the balance of benefits and harms in context, based on the propensity-matched analysis, the number needed to treat with azithromycin was 21 to prevent 1 death within 90 days, compared with a number needed to harm of 144 for myocardial infarction. This corresponds to a net benefit of around 7 deaths averted for 1 nonfatal myocardial infarction induced."

"These findings are consistent with a net benefit associated with azithromycin use in patients hospitalized for pneumonia."


Story Source:

The above story is based on materials provided by The JAMA Network Journals. Note: Materials may be edited for content and length.


Journal Reference:

  1. Eric M. Mortensen, Ethan A. Halm, Mary Jo Pugh, Laurel A. Copeland, Mark Metersky, Michael J. Fine, Christopher S. Johnson, Carlos A. Alvarez, Christopher R. Frei, Chester Good, Marcos I. Restrepo, John R. Downs, Antonio Anzueto. Association of Azithromycin With Mortality and Cardiovascular Events Among Older Patients Hospitalized With Pneumonia. JAMA, 2014; 311 (21): 2199 DOI: 10.1001/jama.2014.4304

Cite This Page:

The JAMA Network Journals. "Outcomes for older adults with pneumonia who receive treatment including azithromycin." ScienceDaily. ScienceDaily, 3 June 2014. <www.sciencedaily.com/releases/2014/06/140603162134.htm>.
The JAMA Network Journals. (2014, June 3). Outcomes for older adults with pneumonia who receive treatment including azithromycin. ScienceDaily. Retrieved November 29, 2014 from www.sciencedaily.com/releases/2014/06/140603162134.htm
The JAMA Network Journals. "Outcomes for older adults with pneumonia who receive treatment including azithromycin." ScienceDaily. www.sciencedaily.com/releases/2014/06/140603162134.htm (accessed November 29, 2014).

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