Benefits of Azithromycin Outweigh Risks in Elderly Hospitalized with Pneumonia

Among patients aged 65 years or older who are hospitalized with community-acquired pneumonia (CAP), azithromycin lowers the risk of 90-day mortality in exchange for slightly increased odds of myocardial infarction (MI) compared to other antibiotic regimens.

Using data collected across US Department of Veterans Affairs (VA) acute care hospitals, Eric M. Mortensen, MD, MSc, of the Dallas VA Medical Center, and colleagues found 90-day mortality was significantly reduced in veterans who received azithromycin. (Figure 1) Furthermore, azithromycin treatment prevented 7 deaths for every nonfatal MI within the first 90 days of hospitalization.

The findings, which were reported in the June 4, 2014, edition of JAMA, were consistent with a net benefit associated with azithromycin use and confirmed the advantage of using azithromycin to prevent death from CAP.

For their study, Mortensen and his co-authors identified 73,690 patients from 118 VA hospitals who were aged 65 years or older when they were admitted for CAP between 2002 and 2012. All of the patients had received guideline-recommended combination antibiotic therapy either with or without azithromycin.

Although the veterans who were treated with azithromycin had a small yet significant increased odds of MI compared to those treated with other drugs, they did not have a significantly increased risk of experiencing cardiac arrhythmias, heart failure, or any cardiac event.