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Noteworthy Publications

Azithromycin-based treatment for older patients hospitalized with pneumonia is linked to lower 90-day mortality

Pneumonia and influenza together are the eighth leading cause of death and the leading cause of death by infection in the United States. Current practice guidelines for treating pneumonia recommend a combination therapy with macrolides (a class of antibiotics), including azithromycin, as the first-line therapy for patient hospitalized with pneumonia. Recent research, however, has suggested that azithromycin may be associated with increased cardiovascular events, such as heart attacks.

A team led by Dr. Eric M. Mortensen of the VA North Texas Health Care System and the University of Texas Southwestern Medical Center in Dallas assessed the association of azithromycin use and treatment outcomes within 90 days of hospital admission, including cardiovascular events and death, for patients 65 years and older who were hospitalized with pneumonia at any VA acute care hospital from 2002 through 2012.

The team matched 31,863 patients who received azithromycin with 31,863 patients who received some other therapy. They found that treatment that included azithromycin, versus other antibiotics, was associated with a slightly increased risk (5.1 percent vs. 4.4 percent) of heart attack—but a significantly lower risk of death (17.4 percent vs. 22.3 percent).

These findings, the researchers wrote, translate into around seven deaths averted for every nonfatal heart attack induced. Overall, they conclude, there is a net benefit associated with azithromycin use in patients hospitalized for pneumonia. (Journal of the American Medical Association, June 4, 2014)

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