title: Cardiac risks associated with antibiotics: azithromycin and levofloxacin.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of South Carolina, South Carolina College of Pharmacy, Clinical Pharmacy and Outcomes Sciences Department , 715 Sumter Street, CLS Building, Room 311G, Columbia, SC 29208 , USA +1 803 777 2653 ; +1 803 777 2820 ; luk@sccp.sc.edu.
authors.forename: Zhiqiang Kevin
authors.initials: ZK
authors.lastname: Lu
authors.forename: Jing
authors.initials: J
authors.lastname: Yuan
authors.forename: Minghui
authors.initials: M
authors.lastname: Li
authors.forename: S Scott
authors.initials: SS
authors.lastname: Sutton
authors.forename: Gowtham A
authors.initials: GA
authors.lastname: Rao
authors.forename: Sony
authors.initials: S
authors.lastname: Jacob
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects; D017963:Azithromycin / Q000009:adverse effects*; D003643:Death; D006801:Humans; D064704:Levofloxacin / Q000009:adverse effects*; D008133:Long QT Syndrome / Q000139:chemically induced*
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D017963:Azithromycin
keywords: adverse drug reactions; antibiotics; azithromycin; cardiac death; cardiovascular risks; drug safety; infections; levofloxacin; review