title: Cardiac Arrest in Pediatric Patients Receiving Azithromycin.
abstract: To compare outcomes of pediatric patients treated with azithromycin compared with penicillin or cephalosporin. We hypothesized that azithromycin use would not be associated with increased cardiac mortality in the pediatric population.
  
  
  
  Retrospective cohort study from the Pediatric Health Information System database between 2008 and 2012. Patients <19 years of age with a principal diagnosis of community-acquired pneumonia who received an antibiotic were included. Primary outcomes were cardiopulmonary resuscitation (CPR) and mortality. Secondary outcomes were ventricular arrhythmias incidences and readmission for ventricular arrhythmia. Statistical analysis was performed with the χ2test. Multivariable analysis was performed to control for potential confounders among patient, event, and treatment characteristics.
  
  
  
  A total of 82 982 patients (54.3% males) met study criteria. Median age was 2.6 years (IQR 1.2-5.9 years) and median length of stay was 2 days (IQR 2-4 days). Azithromycin was used in 5039 (6.1%); penicillin or cephalosporin was used in 77 943 (93.9%). Overall prevalence of antibiotic-associated CPR was 0.14%. Patients receiving a macrolide antibiotic had a lower prevalence of CPR compared with patients receiving a penicillin or cephalosporin (0.04% vs 0.14%, P = .04), and there was no difference in mortality. Multivariable analysis did not find an association between macrolide use and CPR.
  
  
  
  In contrast to recent adult studies, among children hospitalized for community-acquired pneumonia, azithromycin use was not associated with a greater prevalence of cardiac arrest compared with penicillin or cephalosporin use.
authors.affiliation: Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX. Electronic address: svaldes@bcm.edu.
authors.forename: Santiago O
authors.initials: SO
authors.lastname: Valdés
authors.affiliation: Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Kim
authors.affiliation: Oklahoma Children's Heart Center, Oklahoma University Health Sciences Center, Oklahoma City, OK.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Niu
authors.affiliation: Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
authors.forename: Caridad M
authors.initials: CM
authors.lastname: de la Uz
authors.affiliation: Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
authors.forename: Christina Y
authors.initials: CY
authors.lastname: Miyake
authors.affiliation: Department of Pharmacy, Texas Children's Hospital, Houston, TX.
authors.forename: Brady S
authors.initials: BS
authors.lastname: Moffett
mesh_terms: D017963:Azithromycin / Q000009:adverse effects* / Q000627:therapeutic use; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality; D002511:Cephalosporins / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D016208:Databases, Factual; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced* / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010406:Penicillins / Q000009:adverse effects / Q000627:therapeutic use; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D002511:Cephalosporins; D010406:Penicillins; D017963:Azithromycin
keywords: arrhythmia; azithromycin; cardiac arrest; cephalosporin; penicillin; ventricular tachycardia