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antibiotics, arrhythmias, and increased death rates


Flox Antibiotics

Alex Proimos

“Azithromycin and levofloxacin [both common Antibiotics] were both associated with elevated risks of death and serious cardiac arrhythmias during standard lengths of prescription.”  Todd Neale from a recent article he wrote for the March 10 edition of MedPage Today.
To many of you I probably sound like a broken record when it comes to ANTIBIOTICS.  This post is just one more reason why you want to avoid these drugs as though your life depends on it.   From previous studies, we already know that two different Antibiotics from the same class (macrolide) are related to increased risk of arrythmias and even sudden cardiac death (Erythromycin and Clarithromycin).  Then; thanks to a study done at Vanderbilt University and published in the May 17, 2012 issue of the New England Journal of Medicine, another drug of the same class was added to the list.   The Vanderbilt group determined that the drug Azithromycin (commonly known as Zithromax, Zithro, or Zmax) caused heart problems as well.  How severe were these?  Listen to the study’s conclusion.  “Patients who took azithromycin had an estimated 47 additional cardiovascular deaths per 1 million 5-day courses of therapy“.  Let’s find out what this really means.
If we break this down with a calculator, it means that for every 21,276 5-day rounds of Azithromycin prescribed, one additional person will die of heart-related issues.  Looking at the “Liver Tox” section of the NIH’s National Library of Medicine, I found the following quote pertaining to this drug.  “Currently more than 40 million prescriptions are filled yearly making it one of the most commonly prescribed medications in America.”  By doing some more simple math (about all that I am capable of), we can see that when we divide 40 million by 21,276, we get 1880.  In other words, nearly 2,000 people a year are dying of cardiovascular problems brought on by a single Antibiotic — Zithromax.  Interestingly enough, the information on the government’s site mentions several different side effects of this drug, but fails to mention even a single potential cardiovascular event.  Just be aware that the FDA deemed this problem serious enough to include a Warning Bulletin (AZITHROMYCIN & THE RISK OF CARDIOVASCULAR DEATH).  However, the warning did not stop with Zithromax.
The FDA went on to say that, “The risks of cardiovascular death associated with Levofloxacin treatment were similar to those associated with Azithromycin treatment.”  If you recall, I have written about Levofloxacin as well as its siblings (all the various drugs from the “flox” family) previously.  These are the Antibiotics which are associated with tendon ruptures, tendon degeneration, TENDINOSIS, and Chronic Pain (HERE & HERE).  Ask our square dancing buddy _ _ _ _ about this one.  Anyway, I mention all of this to discuss a brand new study on this topic from the University of South Carolina (Azithromycin and Levofloxacin Use and Increased Risk of Cardiac Arrhythmia and Death) which was published in the latest issue of the Annals of Family Medicine.  They duplicated the findings mentioned above by looking at the records of 14 million veterans at 140 different VA clinics / hospitals.

Dr. Gowtham Rao and colleagues found the risk of all-cause death and arrythmias were 48% greater and 77 percent greater respectively for the Zithro group as compared to Amoxocillin.  But that was not the thing I found most interesting.  The comments by Dr. Thomas Amoroso (MD MPH) on a MedPage Today article talking about this study were telling.  After talking about the study hopefully putting another dent in overuse / misuse of Antibiotics, he invokes EVIDENCE-BASED MEDICINE and then says, “What is the absolute risk?  Stating a relative risk without a context in which to put it is, in my personal opinion, a form of statistical malpractice everyone should avoid.  Especially those of us who would like physicians to alter their behavior in evidence based ways; if we cheat, we make it OK for anyone to cheat.”  One of these days we will cover Absolute Risk -vs- Relative Risk in medical studies, but I have to go now.


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