Kieran L Quinn1,2, Erin M Macdonald3, Tara Gomes3,4,5, Muhammad M Mamdani3,4,5,6,7, Anjie Huang3, David N Juurlink3,4,5,8. 1. Department of Internal Medicine, University of Toronto, Toronto, ON, Canada. kieran.quinn@oneid.on.ca. 2. Sunnybrook Health Sciences Centre, 2075 Bayview Avenue G106, Toronto, ON, M4N 3M5, Canada. kieran.quinn@oneid.on.ca. 3. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. 4. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. 5. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. 6. King Saud University, Riyadh, Saudi Arabia. 7. Sunnybrook Research Institute, Toronto, ON, Canada. 8. Sunnybrook Health Sciences Centre, 2075 Bayview Avenue G106, Toronto, ON, M4N 3M5, Canada.
Abstract
INTRODUCTION: Digoxin is commonly prescribed to elderly patients with heart failure and atrial fibrillation, and macrolide antibiotics markedly increase the risk of digoxin toxicity. OBJECTIVE: The aim was to determine whether, in older patients receiving digoxin, macrolide antibiotics are associated with sudden death. METHODS: We used a population-based, nested, case-control design from January 1, 1994 to December 31, 2012 in a cohort of Ontario residents aged 66 years or older prescribed digoxin. The primary outcome was the risk of sudden death within 14 days of exposure to one of three antibiotics (erythromycin, clarithromycin, or azithromycin), relative to cefuroxime. RESULTS: Among 39,072 Ontarians who died suddenly while receiving digoxin, 586 died within 14 days of receiving a study antibiotic. Relative to cefuroxime, we found no statistically significant increase in the risk of sudden death following treatment with erythromycin [adjusted odds ratio (aOR) 0.98; 95% confidence interval (CI) 0.65-1.48], clarithromycin (aOR 1.25; 95% CI 0.94-1.65), or azithromycin (aOR 1.07; 95% CI 0.75-1.53). CONCLUSION: This finding reinforces the cardiovascular safety of macrolide antibiotics in a high-risk population.
INTRODUCTION:Digoxin is commonly prescribed to elderly patients with heart failure and atrial fibrillation, and macrolide antibiotics markedly increase the risk of digoxintoxicity. OBJECTIVE: The aim was to determine whether, in older patients receiving digoxin, macrolide antibiotics are associated with sudden death. METHODS: We used a population-based, nested, case-control design from January 1, 1994 to December 31, 2012 in a cohort of Ontario residents aged 66 years or older prescribed digoxin. The primary outcome was the risk of sudden death within 14 days of exposure to one of three antibiotics (erythromycin, clarithromycin, or azithromycin), relative to cefuroxime. RESULTS: Among 39,072 Ontarians who died suddenly while receiving digoxin, 586 died within 14 days of receiving a study antibiotic. Relative to cefuroxime, we found no statistically significant increase in the risk of sudden death following treatment with erythromycin [adjusted odds ratio (aOR) 0.98; 95% confidence interval (CI) 0.65-1.48], clarithromycin (aOR 1.25; 95% CI 0.94-1.65), or azithromycin (aOR 1.07; 95% CI 0.75-1.53). CONCLUSION: This finding reinforces the cardiovascular safety of macrolide antibiotics in a high-risk population.
Entities:
Keywords:
Azithromycin; Clarithromycin; Digoxin; Index Date; Sudden Death
Authors: Kirkwood F Adams; Jalal K Ghali; J Herbert Patterson; Wendy Gattis Stough; Javed Butler; Jerry L Bauman; Hector O Ventura; Hani Sabbah; John I Mackowiak; Dirk J van Veldhuisen Journal: Eur J Heart Fail Date: 2014-02-23 Impact factor: 15.534
Authors: Michael Fralick; Erin M Macdonald; Tara Gomes; Tony Antoniou; Simon Hollands; Muhammad M Mamdani; David N Juurlink Journal: BMJ Date: 2014-10-30
Authors: Kieran L Quinn; Amy T Hsu; Glenys Smith; Nathan Stall; Allan S Detsky; Dio Kavalieratos; Douglas S Lee; Chaim M Bell; Peter Tanuseputro Journal: J Am Heart Assoc Date: 2020-02-19 Impact factor: 5.501
Authors: Mirjam Hempenius; Kim Luijken; Anthonius de Boer; Olaf Klungel; Rolf Groenwold; Helga Gardarsdottir Journal: Pharmacoepidemiol Drug Saf Date: 2020-05-11 Impact factor: 2.890