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Risks of cardiac arrhythmia and mortality among patients using new-generation macrolides, fluoroquinolones, and β-lactam/β-lactamase inhibitors: a Taiwanese nationwide study.
Clin Infect Dis. 2015 Feb 15; 60(4):566-77.CI

Abstract

BACKGROUND

Previous studies have demonstrated increased cardiovascular mortality related to azithromycin and levofloxacin. Risks associated with alternative drugs in the same class, including clarithromycin and moxifloxacin, were unknown. We used the Taiwan National Health Insurance Database to perform a nationwide, population-based study comparing the risks of ventricular arrhythmia and cardiovascular death among patients using these antibiotics.

METHODS

Between January 2001 and November 2011, a total of 10 684 100 patients were prescribed oral azithromycin, clarithromycin, moxifloxacin, levofloxacin, ciprofloxacin, or amoxicillin-clavulanate at outpatient visits. A logistic regression model adjusted for propensity score was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for adverse cardiac outcomes occurring within 7 days after the initiation of antibiotic treatment.

RESULTS

Compared with amoxicillin-clavulanate treatment, the use of azithromycin and moxifloxacin was associated with significant increases in the risks of ventricular arrhythmia and cardiovascular death. The adjusted ORs for ventricular arrhythmia were 4.32 (95% CI, 2.95-6.33) for azithromycin, 3.30 (95% CI, 2.07-5.25) for moxifloxacin, and 1.41 (95% CI, .91-2.18) for levofloxacin. For cardiovascular death, the adjusted ORs for azithromycin, moxifloxacin, and levofloxacin were 2.62 (95% CI, 1.69-4.06), 2.31 (95% CI, 1.39-3.84), and 1.77 (95% CI, 1.22-2.59), respectively. No association was noted between clarithromycin or ciprofloxacin and adverse cardiac outcomes.

CONCLUSIONS

Healthcare professionals should consider the small but significant increased risk of ventricular arrhythmia and cardiovascular death when prescribing azithromycin and moxifloxacin. Additional research is needed to determine whether the increased risk of mortality is caused by the drugs or related to the severity of infection or the pathogens themselves.

Authors+Show Affiliations

Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei.College of Medicine, I-Shou University and Department of Internal Medicine, E-Da Hospital, Kaohsiung Department of Internal Medicine, National Taiwan University Hospital, Taipei.Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei Department of Internal Medicine, National Taiwan University Hospital, Taipei.Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei Department of Internal Medicine, National Taiwan University Hospital, Taipei Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu.Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital.Graduate Institute of Oncology, College of Medicine, National Taiwan University Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25409476

Citation

Chou, Hsu-Wen, et al. "Risks of Cardiac Arrhythmia and Mortality Among Patients Using New-generation Macrolides, Fluoroquinolones, and Β-lactam/β-lactamase Inhibitors: a Taiwanese Nationwide Study." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 60, no. 4, 2015, pp. 566-77.
Chou HW, Wang JL, Chang CH, et al. Risks of cardiac arrhythmia and mortality among patients using new-generation macrolides, fluoroquinolones, and β-lactam/β-lactamase inhibitors: a Taiwanese nationwide study. Clin Infect Dis. 2015;60(4):566-77.
Chou, H. W., Wang, J. L., Chang, C. H., Lai, C. L., Lai, M. S., & Chan, K. A. (2015). Risks of cardiac arrhythmia and mortality among patients using new-generation macrolides, fluoroquinolones, and β-lactam/β-lactamase inhibitors: a Taiwanese nationwide study. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 60(4), 566-77. https://doi.org/10.1093/cid/ciu914
Chou HW, et al. Risks of Cardiac Arrhythmia and Mortality Among Patients Using New-generation Macrolides, Fluoroquinolones, and Β-lactam/β-lactamase Inhibitors: a Taiwanese Nationwide Study. Clin Infect Dis. 2015 Feb 15;60(4):566-77. PubMed PMID: 25409476.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risks of cardiac arrhythmia and mortality among patients using new-generation macrolides, fluoroquinolones, and β-lactam/β-lactamase inhibitors: a Taiwanese nationwide study. AU - Chou,Hsu-Wen, AU - Wang,Jiun-Ling, AU - Chang,Chia-Hsuin, AU - Lai,Chao-Lun, AU - Lai,Mei-Shu, AU - Chan,K Arnold, Y1 - 2014/11/18/ PY - 2014/11/20/entrez PY - 2014/11/20/pubmed PY - 2015/9/4/medline KW - azithromycin KW - cardiovascular death KW - levofloxacin. KW - moxifloxacin KW - ventricular arrhythmia SP - 566 EP - 77 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 60 IS - 4 N2 - BACKGROUND: Previous studies have demonstrated increased cardiovascular mortality related to azithromycin and levofloxacin. Risks associated with alternative drugs in the same class, including clarithromycin and moxifloxacin, were unknown. We used the Taiwan National Health Insurance Database to perform a nationwide, population-based study comparing the risks of ventricular arrhythmia and cardiovascular death among patients using these antibiotics. METHODS: Between January 2001 and November 2011, a total of 10 684 100 patients were prescribed oral azithromycin, clarithromycin, moxifloxacin, levofloxacin, ciprofloxacin, or amoxicillin-clavulanate at outpatient visits. A logistic regression model adjusted for propensity score was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for adverse cardiac outcomes occurring within 7 days after the initiation of antibiotic treatment. RESULTS: Compared with amoxicillin-clavulanate treatment, the use of azithromycin and moxifloxacin was associated with significant increases in the risks of ventricular arrhythmia and cardiovascular death. The adjusted ORs for ventricular arrhythmia were 4.32 (95% CI, 2.95-6.33) for azithromycin, 3.30 (95% CI, 2.07-5.25) for moxifloxacin, and 1.41 (95% CI, .91-2.18) for levofloxacin. For cardiovascular death, the adjusted ORs for azithromycin, moxifloxacin, and levofloxacin were 2.62 (95% CI, 1.69-4.06), 2.31 (95% CI, 1.39-3.84), and 1.77 (95% CI, 1.22-2.59), respectively. No association was noted between clarithromycin or ciprofloxacin and adverse cardiac outcomes. CONCLUSIONS: Healthcare professionals should consider the small but significant increased risk of ventricular arrhythmia and cardiovascular death when prescribing azithromycin and moxifloxacin. Additional research is needed to determine whether the increased risk of mortality is caused by the drugs or related to the severity of infection or the pathogens themselves. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/25409476/Risks_of_cardiac_arrhythmia_and_mortality_among_patients_using_new_generation_macrolides_fluoroquinolones_and_β_lactam/β_lactamase_inhibitors:_a_Taiwanese_nationwide_study_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciu914 DB - PRIME DP - Unbound Medicine ER -