Azithromycin (Zpack) and levofloxacin (Levaquin) carry higher arrhythmia and mortality
risks than amoxicillin, according to an observational study in the
Annals of Family Medicine. The FDA issued a cardiac warning on
azithromycin in March 2013.
Researchers studied nearly 1.8 million U.S. veterans (mean age, 57)
who received outpatient prescriptions for one of the three antibiotics
from 1999 to 2012. On weighted analysis, the numbers of deaths by day
5 of treatment per million antibiotics dispensed were 154 for
amoxicillin, 228 for azithromycin, and 384 for levofloxacin. Patients
receiving azithromycin had roughly a 50% increased risk for death and
an 80% increased risk for serious arrhythmia, compared with those on
amoxicillin. Risk increases were even greater for levofloxacin.
The researchers conclude: “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.”
Annals of Family Medicine article