Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
N Engl J Med. 2013 May 2;368(18):1704-12. doi: 10.1056/NEJMoa1300799.
Azithromycin use is associated with an increased risk of death from cardiovascular causes among patients at high baseline risk. Whether azithromycin confers a similar risk in the unselected general population is unknown.
We conducted a nationwide historical cohort study involving Danish adults (18 to 64 years of age), linking registry data on filled prescriptions, causes of death, and patient characteristics for the period from 1997 through 2010. We estimated rate ratios for death from cardiovascular causes, comparing 1,102,050 episodes of azithromycin use with no use of antibiotic agents (matched in a 1:1 ratio according to propensity score, for a total of 2,204,100 episodes) and comparing 1,102,419 episodes of azithromycin use with 7,364,292 episodes of penicillin V use (an antibiotic with similar indications; analysis was conducted with adjustment for propensity score).
The risk of death from cardiovascular causes was significantly increased with current use of azithromycin (defined as a 5-day treatment episode), as compared with no use of antibiotics (rate ratio, 2.85; 95% confidence interval [CI], 1.13 to 7.24). The analysis relative to an antibiotic comparator included 17 deaths from cardiovascular causes during current azithromycin use (crude rate, 1.1 per 1000 person-years) and 146 during current penicillin V use (crude rate, 1.5 per 1000 person-years). With adjustment for propensity scores, current azithromycin use was not associated with an increased risk of cardiovascular death, as compared with penicillin V (rate ratio, 0.93; 95% CI, 0.56 to 1.55). The adjusted absolute risk difference for current use of azithromycin, as compared with penicillin V, was -1 cardiovascular death (95% CI, -9 to 11) per 1 million treatment episodes.
Azithromycin use was not associated with an increased risk of death from cardiovascular causes in a general population of young and middle-aged adults. (Funded by the Danish Medical Research Council.).
阿奇霉素在基线风险较高的患者中与心血管原因导致的死亡风险增加有关。阿奇霉素在未选择的普通人群中是否具有相似的风险尚不清楚。
我们进行了一项全国性的历史队列研究，涉及丹麦成年人（18 至 64 岁），将 1997 年至 2010 年期间的用药记录、死亡原因和患者特征与登记处数据相关联。我们通过比较 1102050 例阿奇霉素治疗与未使用抗生素的治疗（根据倾向评分进行 1:1 匹配，总计 2204100 例），以及比较 1102419 例阿奇霉素治疗与 7364292 例青霉素 V 治疗（具有相似适应症的抗生素；分析通过调整倾向评分进行），评估了心血管原因导致死亡的比率比。
与未使用抗生素相比，当前使用阿奇霉素（定义为 5 天疗程）与心血管原因导致的死亡风险显著增加（比率比，2.85；95%置信区间[CI]，1.13 至 7.24）。与抗生素对照剂的分析包括当前阿奇霉素治疗期间的 17 例心血管原因导致的死亡（粗死亡率，1.1/1000 人年）和当前青霉素 V 治疗期间的 146 例（粗死亡率，1.5/1000 人年）。调整倾向评分后，与青霉素 V 相比，当前阿奇霉素的使用与心血管死亡风险增加无关（比率比，0.93；95%CI，0.56 至 1.55）。与青霉素 V 相比，当前使用阿奇霉素的调整绝对风险差异为每 100 万治疗例数减少 1 例心血管死亡（95%CI，-9 至 11）。
在年轻和中年普通人群中，阿奇霉素的使用与心血管原因导致的死亡风险增加无关。（由丹麦医学研究理事会资助）。
