Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago.
Flatiron Health, Inc, New York, New York.
JAMA Netw Open. 2020 Sep 1;3(9):e2016864. doi: 10.1001/jamanetworkopen.2020.16864.
Conflicting evidence exists on the association between azithromycin use and cardiac events.
To compare the odds of cardiac events among new users of azithromycin relative to new users of amoxicillin using real-world data.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from Truven Health Analytics MarketScan database from January 1, 2009, to June 30, 2015. Patients receiving either amoxicillin or azithromycin and enrolled in a health care plan 365 days before (baseline period) the dispensing date (index date) were included in the study. Patients were matched 1:1 on high-dimensional propensity scores. Data were analyzed from October 1, 2018, to December 31, 2019.
New use of azithromycin compared with new use of amoxicillin.
The primary outcome consisted of cardiac events, including syncope, palpitations, ventricular arrhythmias, cardiac arrest, or death as a primary diagnosis for hospitalization at 5, 10, and 30 days from the index date. Logistic regression models were used to estimate odds ratios (ORs) with 95% CIs.
After matching, the final cohort included 2 141 285 episodes of each index therapy (N = 4 282 570) (mean [SD] age of patients, 35.7 [22.3] years; 52.6% female). Within 5 days after therapy initiation, 1474 cardiac events (0.03%) occurred (708 in the amoxicillin cohort and 766 in the azithromycin cohort). The 2 most frequent events were syncope (1032 [70.0%]) and palpitations (331 [22.5%]). The odds of cardiac events with azithromycin compared with amoxicillin were not significantly higher at 5 days (OR, 1.08; 95% CI, 0.98-1.20), 10 days (OR, 1.05; 95% CI, 0.97-1.15), and 30 days (OR, 0.98; 95% CI, 0.92-1.04). Among patients receiving any concurrent QT-prolonging drug, the odds of cardiac events with azithromycin were 1.40 (95% CI, 1.04-1.87) greater compared with amoxicillin. Among patients 65 years or older and those with a history of cardiovascular disease and other risk factors, no increased risk of cardiac events with azithromycin was noted.
This study found no association of cardiac events with azithromycin compared with amoxicillin except among patients using other QT-prolonging drugs concurrently. Although azithromycin is a safe therapy, clinicians should carefully consider its use among patients concurrently using other QT-prolonging drugs.
关于阿奇霉素的使用与心脏事件之间的关联，存在相互矛盾的证据。
使用真实世界的数据，比较新使用阿奇霉素的患者与新使用阿莫西林的患者心脏事件的发生几率。
设计、设置和参与者：这项回顾性队列研究使用了 Truven Health Analytics MarketScan 数据库的数据，时间范围为 2009 年 1 月 1 日至 2015 年 6 月 30 日。在配药日期（索引日期）前 365 天（基线期），纳入接受阿莫西林或阿奇霉素治疗且参加了医疗保健计划的患者。采用高维倾向评分进行 1:1 匹配。数据于 2018 年 10 月 1 日至 2019 年 12 月 31 日进行分析。
新使用阿奇霉素与新使用阿莫西林的情况。
主要结局是心脏事件，包括索引日期后 5、10 和 30 天内因住院而出现晕厥、心悸、室性心律失常、心脏骤停或死亡的情况。采用 logistic 回归模型来估计比值比（OR）及其 95%置信区间（CI）。
在匹配后，最终队列纳入了每个索引治疗的 2 141 285 例（共 4 282 570 例）（患者的平均[SD]年龄为 35.7[22.3]岁；52.6%为女性）。在治疗开始后 5 天内，发生了 1474 例心脏事件（0.03%）（阿莫西林组 708 例，阿奇霉素组 766 例）。最常见的 2 个事件是晕厥（1032 例[70.0%]）和心悸（331 例[22.5%]）。与阿莫西林相比，阿奇霉素治疗后 5 天（OR，1.08；95%CI，0.98-1.20）、10 天（OR，1.05；95%CI，0.97-1.15）和 30 天（OR，0.98；95%CI，0.92-1.04）发生心脏事件的几率无显著差异。在同时使用任何延长 QT 间期药物的患者中，与阿莫西林相比，阿奇霉素发生心脏事件的几率高 1.40（95%CI，1.04-1.87）。在 65 岁及以上的患者以及有心血管疾病病史和其他风险因素的患者中，未发现阿奇霉素与心脏事件风险增加有关。
这项研究发现，与阿莫西林相比，阿奇霉素与心脏事件无关，除非同时使用其他延长 QT 间期的药物。尽管阿奇霉素是一种安全的治疗方法，但临床医生在为同时使用其他延长 QT 间期药物的患者使用阿奇霉素时应谨慎考虑。
