Azithromycin and levofloxacin showed discordant results regarding cardiovascular death risk across 25 reviewed studies, with some showing increased risk versus amoxicillin and others no difference.
Do azithromycin and levofloxacin increase the risk of cardiovascular death or QT prolongation compared to other antibiotics?
The cardiovascular risks of azithromycin and levofloxacin, particularly QT prolongation and cardiovascular death, remain discordant across studies, necessitating careful risk-benefit consideration before prescribing.
INTRODUCTION: Azithromycin and levofloxacin have been shown to be efficacious in treating infections. The adverse drug events associated with azithromycin and levofloxacin were considered rare. However, the US FDA released warnings regarding the possible risk of QT prolongation with azithromycin and levofloxacin. AREAS COVERED: Case reports/case series, observational studies and clinical trials assessing cardiovascular risks associated with azithromycin and levofloxacin were critically reviewed, including 15 case reports/series, 5 observational studies and 5 clinical trials that investigated the cardiac risks associated azithromycin and levofloxacin. EXPERT OPINION: Results are discordant. Two retrospective studies utilizing large databases demonstrated an increased risk of cardiovascular death with azithromycin, when azithromycin was compared with amoxicillin. Two other retrospective studies found no difference in cardiovascular death associated with azithromycin and other antibiotics. For levofloxacin, the increased risk of cardiovascular death was only found in one retrospective study. Therefore, the risks and benefits of antibacterial therapies should be considered when making prescription decisions. This study should not preclude clinicians from avoiding azithromycin and levofloxacin. If a patient has an indication to receive an antibiotic and if azithromycin or levofloxacin is needed, it may be used, but the potential risks must be understood.
Lu et al. (Wed,) conducted a review in Infections. Azithromycin and levofloxacin vs. Amoxicillin and other antibiotics was evaluated on Cardiovascular death and QT prolongation. Azithromycin and levofloxacin showed discordant results regarding cardiovascular death risk across 25 reviewed studies, with some showing increased risk versus amoxicillin and others no difference.