UMEM Educational Pearls

Category: Toxicology

Title: Azithromycin and the Risk of Cardiovascular Death

Keywords: azithromycin, cardiovascular, death (PubMed Search)

Posted: 6/12/2012 by Bryan Hayes, PharmD (Emailed: 6/14/2012) (Updated: 6/15/2012)
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  • Several macrolide antibiotics can cause QTc prolongation and dysrhythmias (e.g., erythromycin), but azithromycin is thought to have little cardiotoxicity.
  • A cohort of patients taking azithromycin was compared to those taking no antibiotics, amoxicillin, ciprofloxacin, or levofloxacin.
  • When compared to no antibiotics, amoxicillin, and ciprofloxacin, azithromycin was associated with a small but significant increased risk of cardiovascular death. Azithromycin was similar to levofloxacin.
  • Important points:
    • Increased risk translates to 47 additional deaths per 1 million prescriptions.
    • Increased risk only occurs during the 5 day course and does not carry on after discontinuation.
    • Patients most likely to die were in the highest risk category based on preexisting cardiovascular diseases (245 deaths per 1 million prescriptions).
  • Bottom line: Patients may start asking about this study finding when given a prescription for azithromycin. Although a small risk, it may be prudent to prescribe an alternative if patients have preexisting cardiovascular disease.



Ray WA, Murray KT, Hall K, et al. Azithromycin and the Risk of Cardiac Death. N Engl J Med 2012;366:1881-90.

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