Z-pak Linked to Heart Disease Deaths

Another interesting study was published yesterday in the New England Journal of Medicine in which the authors linked the use of ubiquitous azithromycin, commonly prescribed as a Z-pak, to a small but statistically significant increase risk of cardiovascular death compared to those patients prescribed amoxicillin or nothing at all for their upper respiratory infections.

Granted, the overall risk was exceedingly small, requiring comparison of 347,795 cases prescribed azithromycin to 1,391,180 controls (no antibiotics) as well as to 1,348,672 prescribed amoxicillin, 264,626 prescribed ciprofloxacin, and 193.906 prescribed levofloxacin.  In fact, the authors calculated that azithromycin was associated w/85 deaths per 1 million prescriptions compared to just 32 deaths per 1 million amoxicillin prescription.  Those who took no antibiotics died at a rate of 30 per 1 million.

But why take that unnecessary risk?  Remember the recent Choosing Wisely campaign?  Number two on the list for family physicians was avoiding antibiotics for mild-to-moderate sinusitis less than 7 days duration.  When do you need antibiotics?  AAAAI & AAFP came out w/similar recommendations in consensus w/Consumer Reports Health.  As I teach my residents (and patients), there are no free lunches (especially at the School of Medicine since pharmaceutical companies signed off on the revised guidelines regarding interactions w/healthcare professionals) as every medication is actually a double-edged sword.  So choose wisely!

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