Rao Gowtham A, Mann Joshua R, Shoaibi Azza, Bennett Charles Lee, Nahhas Georges, Sutton S Scott, Jacob Sony, Strayer Scott M
Department of Family and Preventive Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina.
Ann Fam Med. 2014 Mar-Apr;12(2):121-7. doi: 10.1370/afm.1601.
Azithromycin use has been associated with increased risk of death among patients at high baseline risk, but not for younger and middle-aged adults. The Food and Drug Administration issued a public warning on azithromycin, including a statement that the risks were similar for levofloxacin. We conducted a retrospective cohort study among US veterans to test the hypothesis that taking azithromycin or levofloxacin would increase the risk of cardiovascular death and cardiac arrhythmia compared with persons taking amoxicillin.
We studied a cohort of US veterans (mean age, 56.8 years) who received an exclusive outpatient dispensation of either amoxicillin (n = 979,380), azithromycin (n = 594,792), or levofloxacin (n = 201,798) at the Department of Veterans Affairs between September 1999 and April 2012. Azithromycin was dispensed mostly for 5 days, whereas amoxicillin and levofloxacin were dispensed mostly for at least 10 days.
During treatment days 1 to 5, patients receiving azithromycin had significantly increased risk of death (hazard ratio [HR] = 1.48; 95% CI, 1.05-2.09) and serious arrhythmia (HR = 1.77; 95% CI, 1.20-2.62) compared with patients receiving amoxicillin. On treatment days 6 to 10, risks were not statistically different. Compared with patients receiving amoxicillin, patients receiving levofloxacin for days 1 to 5 had a greater risk of death (HR = 2.49, 95% CI, 1.7-3.64) and serious cardiac arrhythmia (HR = 2.43, 95% CI, 1.56-3.79); this risk remained significantly different for days 6 to 10 for both death (HR = 1.95, 95% CI, 1.32-2.88) and arrhythmia (HR = 1.75; 95% CI, 1.09-2.82).
Compared with amoxicillin, azithromycin resulted in a statistically significant increase in mortality and arrhythmia risks on days 1 to 5, but not 6 to 10. Levofloxacin, which was predominantly dispensed for a minimum of 10 days, resulted in an increased risk throughout the 10-day period.
阿奇霉素的使用与基线风险较高的患者死亡风险增加有关，但对中青年成年人并非如此。美国食品药品监督管理局发布了关于阿奇霉素的公开警告，包括声明左氧氟沙星的风险与之相似。我们在美国退伍军人中进行了一项回顾性队列研究，以检验以下假设：与服用阿莫西林的人相比，服用阿奇霉素或左氧氟沙星会增加心血管死亡和心律失常的风险。
我们研究了一组美国退伍军人（平均年龄56.8岁），他们于1999年9月至2012年4月期间在退伍军人事务部接受了阿莫西林（n = 979,380）、阿奇霉素（n = 594,792）或左氧氟沙星（n = 201,798）的独家门诊配药。阿奇霉素大多配药5天，而阿莫西林和左氧氟沙星大多配药至少10天。
在治疗的第1至5天，与服用阿莫西林的患者相比，服用阿奇霉素的患者死亡风险显著增加（风险比[HR]=1.48；95%置信区间，1.05 - 2.09），严重心律失常风险也显著增加（HR = 1.77；95%置信区间，1.20 - 2.62）。在治疗的第6至10天，风险无统计学差异。与服用阿莫西林的患者相比，服用左氧氟沙星1至5天的患者死亡风险更高（HR = 2.49，95%置信区间，1.7 - 3.64），严重心律失常风险更高（HR = 2.43，95%置信区间，1.56 - 3.79）；在第6至10天，死亡（HR = 1.95，95%置信区间，1.32 - 2.88）和心律失常（HR = 1.75；95%置信区间，1.09 - 2.82）的风险仍有显著差异。
与阿莫西林相比，阿奇霉素在第1至5天导致死亡率和心律失常风险有统计学显著增加，但在第6至10天没有。主要配药至少10天的左氧氟沙星在整个10天期间导致风险增加。
