Antibiotics: It's important to know this

Quiet

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Azithromycin and Levofloxacin Use and Increased Risk of Cardiac Arrhythmia and Death

Gowtham A. Rao, MD, PhD, MPH, Joshua R. Mann, MD, MPH, Azza Shoaibi, BPharm, MPH, Charles Lee Bennett, MD, PhD, MPP, Georges Nahhas, MPH, S. Scott Sutton, PharmD, Sony Jacob, MD, Scott M. Strayer, MD, MPH

From "Annals of Family Medicine"

Results. During treatment days 1 to 5, patients receiving azithromycin had significantly increased risk of death (hazard ratio [HR] = 1.48; 95% CI, 1.05–2.09) and serious arrhythmia (HR = 1.77; 95% CI, 1.20–2.62) compared with patients receiving amoxicillin. On treatment days 6 to 10, risks were not statistically different. Compared with patients receiving amoxicillin, patients receiving levofloxacin for days 1 to 5 had a greater risk of death (HR = 2.49, 95% CI, 1.7–3.64) and serious cardiac arrhythmia (HR = 2.43, 95% CI, 1.56–3.79); this risk remained significantly different for days 6 to 10 for both death (HR = 1.95, 95% CI, 1.32–2.88) and arrhythmia (HR = 1.75; 95% CI, 1.09–2.82).

Conclusions. Compared with amoxicillin, azithromycin resulted in a statistically significant increase in mortality and arrhythmia risks on days 1 to 5, but not 6 to 10. Levofloxacin, which was predominantly dispensed for a minimum of 10 days, resulted in an increased risk throughout the 10-day period.
Lots of people love their 5 day "Z-Packs" or Zithromax... but if your doc prescribes it, you have a 48% higher risk of dying and a 77% risk of a serious heart arrhythmia than Amoxicillin
If your doc prescribes Levaquin (levofloxacin) those risks are much greater still:
150% increase in both death and arrhythmia for the first 5 days, and about
100% increase in risk for the second 5 days.

Next time they want to prescribe this type of antibiotic for me or wifey, I will be asking the doc if plain old Amoxicillin might be a wiser choice.
 

pdm

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Hopefully the bug you got isn't resistant to the antibiotic you want because some pack of douchebags decided that they didn't need to finish their course of treatment because "they felt better". I hope they catch the drug-resistant herpaghonnasyphacrabaids.
 

jar

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What's the risk of amoxicilin? If the increase is going from .00000001% chance of dying to .000000015%, it's hard to get worked up about.
 

Quiet

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What's the risk of amoxicilin? If the increase is going from .00000001% chance of dying to .000000015%, it's hard to get worked up about.
That is very true and is a good point, but I feel that risk is risk and if unnecessary, don't take it.

The number of deaths was in excess of 70 per 100,000 worst case vs about 30 per 100,000..The homicide rate in the US is just under 5 in 100,000. You go through the expense, inconvenience and trouble of carrying a gun to protect yourself, all you have to do is say "Hey, doc...." to afford yourself 10 times the level of protection for a couple of weeks. :-D

 
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not if your doctor gets free shit from pharma sales
Azithromycin is a generic now.

And everyone should probably read up on which antibiotics work well for what before you start refusing meds. Especially if you're not at high risk of cardiac problems in the first place.
 
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What's the risk of amoxicilin? If the increase is going from .00000001% chance of dying to .000000015%, it's hard to get worked up about.
Agreed, but what about the guy with the hard on that lasts for more than four hours?
 
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It's important to post the background and methods too! :)

Was this an observational study or RCT?
 

Quiet

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Azithromycin is a generic now.

And everyone should probably read up on which antibiotics work well for what before you start refusing meds. Especially if you're not at high risk of cardiac problems in the first place.
Who said anything about refusing meds?

I will be asking the doc if plain old Amoxicillin might be a wiser choice
 

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Azithromycin and Levofloxacin Use and Increased Risk of Cardiac Arrhythmia and Death

Gowtham A. Rao, MD, PhD, MPH, Joshua R. Mann, MD, MPH, Azza Shoaibi, BPharm, MPH, Charles Lee Bennett, MD, PhD, MPP, Georges Nahhas, MPH, S. Scott Sutton, PharmD, Sony Jacob, MD, Scott M. Strayer, MD, MPH

From "Annals of Family Medicine"



Lots of people love their 5 day "Z-Packs" or Zithromax... but if your doc prescribes it, you have a 48% higher risk of dying and a 77% risk of a serious heart arrhythmia than Amoxicillin
If your doc prescribes Levaquin (levofloxacin) those risks are much greater still:
150% increase in both death and arrhythmia for the first 5 days, and about
100% increase in risk for the second 5 days.

Next time they want to prescribe this type of antibiotic for me or wifey, I will be asking the doc if plain old Amoxicillin might be a wiser choice.
Or it could just be that since Zithromax and Levo are the preferred drugs for pneumonia, that the increased death rate is simply a result of sicker patients receiving these drugs (infection with pneumonia increased risk of cardiac death). There are some long term studies showing Zithromax does not increase cardiac risk, so I would not get too worked up over an observational study.
 

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Azithromycin and Levofloxacin Use and Increased Risk of Cardiac Arrhythmia and Death

Gowtham A. Rao, MD, PhD, MPH, Joshua R. Mann, MD, MPH, Azza Shoaibi, BPharm, MPH, Charles Lee Bennett, MD, PhD, MPP, Georges Nahhas, MPH, S. Scott Sutton, PharmD, Sony Jacob, MD, Scott M. Strayer, MD, MPH

From "Annals of Family Medicine"



Lots of people love their 5 day "Z-Packs" or Zithromax... but if your doc prescribes it, you have a 48% higher risk of dying and a 77% risk of a serious heart arrhythmia than Amoxicillin
If your doc prescribes Levaquin (levofloxacin) those risks are much greater still:
150% increase in both death and arrhythmia for the first 5 days, and about
100% increase in risk for the second 5 days.

Next time they want to prescribe this type of antibiotic for me or wifey, I will be asking the doc if plain old Amoxicillin might be a wiser choice.
Z-packs don't work anymore. Amoxicillin is close to not being effective. Flying bullets don't scare me as much as drug resistant bugs do. I remember when you felt better hours after taking amoxicillin. Stuff takes 1/2 a week, and even then it's not a guarantee.
 

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Z-packs don't work anymore. Amoxicillin is close to not being effective. Flying bullets don't scare me as much as drug resistant bugs do. I remember when you felt better hours after taking amoxicillin. Stuff takes 1/2 a week, and even then it's not a guarantee.
Bingo, just consulted a pharmMD, Amoxicillin is pretty much useless now as bugs don't fear it and z-packs was over-prescribed for stupid shit like cold, now it's useless as well.
 
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Or it could just be that since Zithromax and Levo are the preferred drugs for pneumonia, that the increased death rate is simply a result of sicker patients receiving these drugs (infection with pneumonia increased risk of cardiac death). There are some long term studies showing Zithromax does not increase cardiac risk, so I would not get too worked up over an observational study.
I would have to agree.

I very rarely go to the Dr for an illness and when I do I'll take my chances with the z-pack (yes, I do understand that antibiotics are becoming less and less effective against ever strengthening bugs) as it's always worked, the very few times I've needed antibiotics during my adult life.
 

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If my microbiology courses have taught me anything, it's that we have doomed ourselves to creating "superbugs" due to our over-prescription of antibiotics. Time to invest in hazmat suits that will fit over my body armor 0_0


Sent from my iPhone using Tapatalk
 

Quiet

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I'm sure they worked very hard and diligently to design their inclusion criteria to control for various and sundry factors. This is a published (ie peer reviewed) study.

I'm not saying it's perfect or even correct; I have no dog in this hunt. You may certainly feel free to draw whatever conclusions you like and to govern yourselves accordingly. ;-)
 

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That is 0.0002% at 5 days for a Z pack. And I'll bet that the deaths are accompanied by significant comorbidities , which are the actual causes of death and not the antibiotic. So if you are a senior citizen, with pneumonia and you die at day 5 while taking Azithromycin, you are included in this number. I'm not worried at all.

That is very true and is a good point, but I feel that risk is risk and if unnecessary, don't take it.

The number of deaths was in excess of 70 per 100,000 worst case vs about 30 per 100,000..The homicide rate in the US is just under 5 in 100,000. You go through the expense, inconvenience and trouble of carrying a gun to protect yourself, all you have to do is say "Hey, doc...." to afford yourself 10 times the level of protection for a couple of weeks. :-D

 

Quiet

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You've got the decimal place off by two positions (it's about .02%), but yeah you're right. It's only about the same risk of dying as being a kidney donor for the zithromax, 3 times that for the course of Levo. It is a very small risk to take for that convenience of 5 or 10 fewer pills (if it's appropriate for your infection).

The donor surgery has a .03% mortality rate (i.e., 3 in 10,000)[(That's 300 in a million -Quiet)]
http://www.kidneyregistry.org/living_donors.php

It's all very preliminary finding of course. Needs much more study. They only selected just under 2 million patient records out of the 14 million they looked at. They were probably paid off by the generic pharmaceutical giants to find a problem. ;-)

OTOH can't really hurt much to ask "Doc, I heard about this study... would amoxicillin be just as effective?"

(You see, unless they culture your bug for a day or three in a petri dish along with various antibiotics, they probably don't really know which one will be better (or effective at all). It's a bit of a crap shoot to begin with).
 

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This is retarded. The data isn't normalized for things like sample bias, etc. For example the 'cillin data might be better because its often deployed against different types of infections vs the other drugs. Then you have people taking the other stuff that can't take the cillins because of possible allergic reactions. Then you have issues where doctors simply don't prescribe something like amoxicillin or whatever because they know that a lot of times it sucks and it might not work. So if someone is facing a life threatening infection, are you going to push the known effective antibiiotic or one that has a substantial chance of not working? There are too many biases built into all these things to draw a conclusion based on a death rate of one drug vs another, when the drugs are not equivalent. If you think that most antibiotics are equivalent (or effective in all cases) you're a numbskull.

ETA: if you're at the doctor and you actually need need an antibiotic, for something brutal, the last thing they're going to do is throw amoxicillin at you. Unless you're like a kid with an ear infection or something like that.

-Mike
 
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drgrant

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So you've read the methodology and selection criteria and have determined it wasn't "normalized for sample bias"?
You didn't even post a link to it, just an excerpt. I doubt it accounts for the weight of input variables, its a cluster****, unless this study perhaps is confined to the treatment of one specific type of infection or something. I don't see a distribution by age group, either. EG, for example nothing in your post tells me whether there is a difference in death rates for these antibiotics between say teenagers, adults, and 65+ crowd.

-Mike
 

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You didn't even post a link to it, just an excerpt. I doubt it accounts for the weight of input variables, its a cluster****, unless this study perhaps is confined to the treatment of one specific type of infection or something. I don't see a distribution by age group, either. EG, for example nothing in your post tells me whether there is a difference in death rates for these antibiotics between say teenagers, adults, and 65+ crowd.

-Mike
OK. I just thought you must have read it and not been assuming they didn't do things the right way.

Sorry, here's the link I missed posting
http://annfammed.org/content/12/2/121.full
 
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You didn't even post a link to it, just an excerpt. I doubt it accounts for the weight of input variables, its a cluster****, unless this study perhaps is confined to the treatment of one specific type of infection or something. I don't see a distribution by age group, either. EG, for example nothing in your post tells me whether there is a difference in death rates for these antibiotics between say teenagers, adults, and 65+ crowd.

-Mike
It's a pretty sophisticated analysis. Age is definitely accounted for in the models, and there are very few teenagers getting care in the VA. The people in the VA who run these studies are really good at what they do, in my experience.
 

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It's a pretty sophisticated analysis. Age is definitely accounted for in the models, and there are very few teenagers getting care in the VA. The people in the VA who run these studies are really good at what they do, in my experience.
It's an interesting study. They did the study to confirm other reports that were already made that there was a higher incidence of death and heart arrhythmia. So it wasn't a prespective study where there's a trial that's double-blind with well designed controls and so forth.

However the study was f'kn huge, looking at millions of patients. So while there are certainly weaknesses as DrGrant is trying to point out and there could be some built in bias it seems to me it would be prudent to ask your doc if IN YOUR CASE it would be wise to try amoxicilin first (or instead).

That's not just my opinion, that's actually the final paragraph of the discussion by the authors of the study. They say it better than I did:

Risks and benefits of antibacterial therapies should be considered when making prescription decisions. As compared with amoxicillin, there was higher risk of death associated with azithromycin therapy administered to US veterans. There are usually multiple antibiotic choices available for older patients, especially those with cardiac comorbidities; physicians may consider prescribing medications other than azithromycin and levofloxacin.
Emphasis mine.
 
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