What’s this about Azithromycin and Heart Problems?

March 14, 2013 drdarria 1 Comments

IMG_0159If you’ve been watching today’s news, you’ve probably heard about the new FDA warning against the antibiotic Azithromycin (known as “Z-Pack”).  This is a WIDELY used antibiotic, so you probably have questions.  Here’s what you need to know in a nutshell.

  • Theoretically, Azithromycin can cause your heart beat to become out of sync, putting you at risk for heart arrhythmias and death (for you “House” fans out there, the arrhythmia is called “Torsades de Pointes”, and you get bonus points if you say it with a french accent)
  • The FDA reviewed data and a study that came out last year (from my home-state of Tennessee, THANK YOU VERY MUCH–GO VOLS!), and showed that for every 1,000,000 (yes, 1 million) prescriptions for azithromycin, there were  50 more deaths than patients that did not receive it.  So, we’re talking VERY small numbers here.
  • Plus, someone who gets a prescription for azithromycin is probably MORE sick than someone who doesn’t get the prescription, right? So, they’re already at higher risk–something that has nothing to do with azithromycin itself.
  • Not to mention: Other antibiotics and other medications can also theoretically put you at risk for this arrhythmia–no medication is 100% “safe”, and each carries its own risk.  (NOTE: even too much water can cause death, so put that away in your “moderation is the key” files!)
  • So what am I doing and what should you do?  We know that certain people were at higher risk of complications–heart disease,  pre-existing heart arrhythmias, low potassium and magnesium, and older age.  Of course, these are also the patients at higher risk of illness from infections.  Now, when I have a patient asking for this antibiotic or in whom I’m considering it, I have a long talk with them.  Naturally, someone with pneumonia or another infection is at risk if I DON’T give them an antibiotic, so as in everything in medicine, it’s about weighing the risks and benefits, and there’s no right answer.
  • So, if you really need the antibiotic, take it.  But it’s also further support for cautious use of all antibiotics, period.

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