Antibiotic linked with rare but deadly heart risk

[J.R.E.]

 I was on this drug for a year, from 2003 -2004. Never had any issues with heart murmurs.



Antibiotic linked with rare but deadly heart risk
By LINDSEY TANNER,
Last Updated: Wednesday, May 16, 2012

CHICAGO --

(AP) — An antibiotic widely used for bronchitis and other common infections seems to increase chances for sudden deadly heart problems, a rare but surprising risk found in a 14-year study.

Zithromax, or azithromycin, is more expensive than other antibiotics, but it's popular because it often can be taken for fewer days. But the results suggest doctors should prescribe other options for people already prone to heart problems,  the researchers and other experts said.

Vanderbilt University researchers analyzed health records and data on millions of prescriptions for several antibiotics given to about 540,000 Tennessee Medicaid patients from 1992 to 2006. There were 29 heart-related deaths among those who took Zithromax during five days of treatment. Their risk of death while taking the drug was more than double that of patients on another antibiotic, amoxicillin, or those who took none.

To compare risks, the researchers calculated that the number of deaths per 1 million courses of antibiotics would be about 85 among Zithromax patients versus 32 among amoxicillin patients and 30 among those on no antibiotics. The highest risks were in Zithromax patients with existing heart problems. 

Patients in each group started out with comparable risks for heart trouble, the researchers said.

The results suggest there would be 47 extra heart-related deaths per 1 million courses of treatment with Zithromax, compared with amoxicillin. A usual treatment course for Zithromax is about five days, versus about 10 days for amoxicillin and other antibiotics. Zithromax is at least twice as expensive as generic amoxicillin; online prescription drug sellers charge a few dollars per pill for Zithromax.

"People need to recognize that the overall risk is low," said Dr. Harlan Krumholz, a Yale University health outcomes specialist who was not involved in the study. More research is needed to confirm the findings, but still, he said patients with heart disease "should probably be steered away" from Zithromax for now.

The study appears in Thursday's New England Journal of Medicine. The National Heart, Lung and Blood Institute helped pay for the research.

Zithromax, marketed by Pfizer Inc., has been available in the United States for two decades. It's often used to treat bronchitis, sinus infections and pneumonia. Wayne Ray, a Vanderbilt professor of medicine, decided to study the drug's risks because of evidence linking it with potential heart rhythm problems. Also, antibiotics in the same class as Zithromax have been linked with sudden cardiac death.   

Zithromax is among top-selling antibiotics. U.S. sales last year totaled $464 million, according to IMS Health, a health care information and services company.

Pfizer issued a statement saying it would thoroughly review the study. "Patient safety is of the utmost importance to Pfizer and we continuously monitor the safety and efficacy of our products to ensure that the benefits and risks are accurately described," the company said.

Patients studied were age 50 on average and not hospitalized. Most had common ailments, including sinus infections and bronchitis. Those on Zithromax were about as healthy as those on other antibiotics, making it unlikely that an underlying condition might explain the increased death risk.

Medicaid patients generally have more disability and lower incomes than other patients, so whether the same results would be found in the general population is uncertain, Ray said.

Dr. Bruce Psaty, a professor of medicine at the University of Washington, said doctors and patients need to know about the potential risks. He said the results also raise concerns about long-term use of Zithromax, which other research suggests could benefit people with severe lung disease. Additional research is needed to determine if that kind of use could be dangerous, he said.

[Ann]

Hmmm indeed Ray. I was told I have a heart murmur a few years ago, which was news to me. When I expressed my surprise to the doctor, he said he doubted it was missed previously because it was quite evident. I've also had zithromax for bronchitis.

[J.R.E.]

Hmmm indeed Ray. I was told I have a heart murmur a few years ago, which was news to me. When I expressed my surprise to the doctor, he said he doubted it was missed previously because it was quite evident. I've also had zithromax for bronchitis.

I was quite surprised when the doctor told me I had heart murmurs.  My HIV doctor, never mentioned this to me, from 2003 to 2009 I always thought I had a healthy beating heart.

It was the VA hospital doctor that discovered the heart murmur in 2010. ANd after the EKG and ECG, it was determined that I had several of them.

I wonder how many others, that may have been on Zithromax, have heart rhythm problems.


By the way, Mine are very evident also, anyone qualified can put a stethoscope to me and hear it.

But I also haven't noticed any physical effects from it.


Yes indeedy,,,HHmmmmm !   


Ray 

[J.R.E.]

From the above article :




   "Also, antibiotics in the same class as Zithromax have been linked with sudden cardiac death"     




I wonder how many of these people were on Zithromax:

http://www.poz.com/articles/hiv_cardiac_death_761_22414.shtml

[newt]

Ta

- matt

[eric48]

Hi Ray,

I understand the concern, but, you may want to get this murmur thing explained to you in details. there are many types and most are clinically irrelevant
If I get it right it is like when a door is a little stiff to open. but, as long as it opens and closes in sync, there is no leakeage and the pump retains its efficiency.

My wife has got murmurs, that, after checking at the local (old-timer) cardiologist, he said it is not relevant. Many people do, in fact (I was told at the time)

I never got a chance to hear that murmur, but, I can swear that she snores... ;-)

Speaking about cardiologist, I just met my new one. First class researcher in HIV related cardio problems.
First interview... He said that, from first impression, I am in the low risk group, but I'll get a complete one day hospital check up (scanners, and what have you)

Here comes the bonus: I also met his young, strongly built, Asian decent assistant doctor: he is to diiiiiie for !
If I get sudden death, don't blame the meds... It will most likely be caused by that SOOOO cute doctor.  :-)

Wishing you well

BTW, I 'll post all results when I get them: the nurse told me they are good...

Cheers! Eric

 

[J.R.E.]

Hello Eric.

The VA hospital, doesn't seem to be that concerned about the murmurs. They think it's something that I've had most of my life.

But I don't believe it.  I was in the Army.  They would / should have detected this 40 years ago, if that was the case, and my previous doctor should have seen this.

But anyway, I'm doing well.  They suggest that if I feel flutters ( which I don't) , or have dizzy spells or lightheadedness, That I should bring it to there attention.

I see my primary care physician next week.

I had an EKG in January of 2010

I had an Echocardiogram done , on August 16th, 2010 

I had another EKG on July 20th, 2011

I had a cardiac stress test done on September 8th, 2011 ( had no problem with that)


The last time I spoke with my primary care, I believe she stated that an EKG and an ECG, will be done annually.


I also had these procedures done with my previous doctor  between 2003, and 2008, with no problems reported, ( and no heart murmurs reported)

If I get sudden death, don't blame the meds... It will most likely be caused by that SOOOO cute doctor.  :-)

Cheers! Eric
 

Or the wife! 

Ray 

[OneTampa]

My heart has been murmuring (with some interesting sidebar conversations) for over 42 years now.   

Seriously, I was informed as a teenager that I have a heart murmur.  It has been the case for years and reaffirmed at my yearly physicals.

[denb45]

My heart has been murmuring day & night every since I was put on lipids 10 yrs ago, my doctor says its nothing to worry about 

I had a EKG back in 2005/2006 and there was no cause for concern 


I see that the ERYPED 200 (erythromycin ethylsuccinate) oral solution I take for my GI-gut-SIBO-issues (to kill all of the bugs) isn't on that list, so I'm not to worried 

[Ann]

I also had an EKG and echocardiogram after the murmur was discovered and I was also told to not worry about it. I don't for the most part, although occasionally when I'm stressed out and have to do something intensely physical (like run), my heart feels a little fluttery. Doesn't happen often enough to worry me (much).