Risks of Cardiac Arrhythmia and Mortality Among Patients Using New-Generation Macrolides, Fluoroquinolones, and β-Lactam/β-Lactamase Inhibitors: A Taiwanese Nationwide Study

被引:66
作者
Chou, Hsu-Wen [1 ]
Wang, Jiun-Ling [2 ,3 ,4 ]
Chang, Chia-Hsuin [1 ,4 ]
Lai, Chao-Lun [1 ,4 ,5 ]
Lai, Mei-Shu [1 ,6 ]
Chan, K. Arnold [7 ,8 ]
机构
[1] Natl Taiwan Univ, Inst Epidemiol & Prevent Med, Coll Publ Hlth, Taipei 10055, Taiwan
[2] I Shou Univ, Coll Med, Kaohsiung, Taiwan
[3] E Da Hosp, Dept Internal Med, Kaohsiung, Taiwan
[4] Natl Taiwan Univ Hosp, Dept Internal Med, Taipei 100, Taiwan
[5] Natl Taiwan Univ Hosp, Dept Internal Med, Hsinchu, Taiwan
[6] Natl Taiwan Univ Hosp, Natl Ctr Excellence Clin Trial & Res, Ctr Comparat Effectiveness Res, Taipei, Taiwan
[7] Natl Taiwan Univ, Coll Med, Grad Inst Oncol, Taipei 10055, Taiwan
[8] Natl Taiwan Univ Hosp, Dept Med Res, Taipei, Taiwan
关键词
ventricular arrhythmia; cardiovascular death; azithromycin; moxifloxacin; levofloxacin; QT INTERVAL PROLONGATION; MYOCARDIAL-INFARCTION; CARDIOVASCULAR EVENTS; PNEUMONIAE INFECTION; ANTIBACTERIAL DRUGS; PROPENSITY SCORE; CLAIMS DATA; DEATH; AZITHROMYCIN; ASSOCIATION;
D O I
10.1093/cid/ciu914
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Previous studies have demonstrated increased cardiovascular mortality related to azithromycin and levofloxacin. Risks associated with alternative drugs in the same class, including clarithromycin and moxifloxacin, were unknown. We used the Taiwan National Health Insurance Database to perform a nationwide, population-based study comparing the risks of ventricular arrhythmia and cardiovascular death among patients using these antibiotics. Methods. Between January 2001 and November 2011, a total of 10 684 100 patients were prescribed oral azithromycin, clarithromycin, moxifloxacin, levofloxacin, ciprofloxacin, or amoxicillin-clavulanate at outpatient visits. A logistic regression model adjusted for propensity score was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for adverse cardiac outcomes occurring within 7 days after the initiation of antibiotic treatment. Results. Compared with amoxicillin-clavulanate treatment, the use of azithromycin and moxifloxacin was associated with significant increases in the risks of ventricular arrhythmia and cardiovascular death. The adjusted ORs for ventricular arrhythmia were 4.32 (95% CI, 2.95-6.33) for azithromycin, 3.30 (95% CI, 2.07-5.25) for moxifloxacin, and 1.41 (95% CI,.91-2.18) for levofloxacin. For cardiovascular death, the adjusted ORs for azithromycin, moxifloxacin, and levofloxacin were 2.62 (95% CI, 1.69-4.06), 2.31 (95% CI, 1.39-3.84), and 1.77 (95% CI, 1.22-2.59), respectively. No association was noted between clarithromycin or ciprofloxacin and adverse cardiac outcomes. Conclusions. Healthcare professionals should consider the small but significant increased risk of ventricular arrhythmia and cardiovascular death when prescribing azithromycin and moxifloxacin. Additional research is needed to determine whether the increased risk of mortality is caused by the drugs or related to the severity of infection or the pathogens themselves.
引用
收藏
页码:566 / 577
页数:12
相关论文
共 32 条
[1]   Role of Cardiac Resynchronization in End-Stage Heart Failure Patients Requiring Inotrope Therapy [J].
Bhattacharya, Sanjoy ;
Abebe, Kaleab ;
Simon, Marc ;
Saba, Samir ;
Adelstein, Evan .
JOURNAL OF CARDIAC FAILURE, 2010, 16 (12) :931-937
[2]   Comparison of logistic regression versus propensity score when the number of events is low and there are multiple confounders [J].
Cepeda, MS ;
Boston, R ;
Farrar, JT ;
Strom, BL .
AMERICAN JOURNAL OF EPIDEMIOLOGY, 2003, 158 (03) :280-287
[3]   Risk of Severe Dysglycemia Among Diabetic Patients Receiving Levofloxacin, Ciprofloxacin, or Moxifloxacin in Taiwan [J].
Chou, Hsu-Wen ;
Wang, Jiun-Ling ;
Chang, Chia-Hsuin ;
Lee, Jen-Jyh ;
Shau, Wen-Yi ;
Lai, Mei-Shu .
CLINICAL INFECTIOUS DISEASES, 2013, 57 (07) :971-980
[4]   Increased Risk of Myocardial Infarction and Stroke Following Exacerbation of COPD [J].
Donaldson, Gavin C. ;
Hurst, John R. ;
Smith, Christopher J. ;
Hubbard, Richard B. ;
Wedzicha, Jadwiga A. .
CHEST, 2010, 137 (05) :1091-1097
[5]  
Executive Yuan. Department of Health, 2011, NAT HLTH INS TAIW 20
[6]   Arrhythmias associated with fluoroquinolone therapy [J].
Falagas, Matthew E. ;
Rafailidis, Petros I. ;
Rosmarakis, Evangelos S. .
INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS, 2007, 29 (04) :374-379
[7]   Azithromycin and risk of sudden cardiac death: Guilty as charged or falsely accused? [J].
Giudicessi, John R. ;
Ackerman, Michael J. .
CLEVELAND CLINIC JOURNAL OF MEDICINE, 2013, 80 (09) :539-544
[8]   Association of influenza virus infection and inflammatory cytokines with acute myocardial infarction [J].
Guan, Xiuru ;
Yang, Wei ;
Sun, Xijuan ;
Wang, Lanfeng ;
Ma, Benjiang ;
Li, Hongyuan ;
Zhou, Jin .
INFLAMMATION RESEARCH, 2012, 61 (06) :591-598
[9]   A comparative study of the fluoroquinolone antibacterial agents on the action potential duration in guinea pig ventricular myocardia [J].
Hagiwara, T ;
Satoh, S ;
Kasai, Y ;
Takasuna, K .
JAPANESE JOURNAL OF PHARMACOLOGY, 2001, 87 (03) :231-234
[10]   Validation of diagnostic codes for outpatient-originating sudden cardiac death and ventricular arrhythmia in Medicaid and Medicare claims data [J].
Hennessy, Sean ;
Leonard, Charles E. ;
Freeman, Cristin P. ;
Deo, Rajat ;
Newcomb, Craig ;
Kimmel, Stephen E. ;
Strom, Brian L. ;
Bilker, Warren B. .
PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, 2010, 19 (06) :555-562