ArticleJournal of the American Heart Association2018
Estimated Cardiac Risk Associated With Macrolides and Fluoroquinolones Decreases Substantially When Adjusting for Patient Characteristics and Comorbidities.
Article in Journal of the American Heart Association, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
23 citing papers in PubMed, 40 citations in OpenAlex.
- Cardiovascular Risk During the 90-Day Vulnerable Window After COPD Exacerbations: A Narrative Review.Life (Basel, Switzerland) · 2026Review
- Cardiovascular adverse effects of common non-oncologic medications: from mechanisms to clinical management.European heart journal. Cardiovascular pharmacotherapy · 2026Review
- Macrolide Antibiotic Mediated Cardiac Arrhythmias: Emerging Concepts and Clinical Implications.Biomedicines · 2025Review
- Substandard and falsified antibiotics are associated with antimicrobial resistance: a retrospective country-level analysis.BMJ global health · 2025Article
- DisseminatedBMJ case reports · 2023Article
- Comparative safety of inhaled corticosteroids and macrolides in Medicare enrolees with bronchiectasis.ERJ open research · 2022Article
- No dose-response relationship of clarithromycin utilization on cardiovascular outcomes in patients with stable coronary heart disease: Analysis of Taiwan's national health insurance claims data.Frontiers in cardiovascular medicine · 2022Article
- Precision Medicine and Adverse Drug Reactions Related to Cardiovascular Drugs.Diseases (Basel, Switzerland) · 2021Review
- Infections as Novel Risk Factors of Atherosclerotic Cardiovascular Diseases: Pathophysiological Links and Therapeutic Implications.Journal of clinical medicine · 2021Review
- Triggering of cardiovascular disease by infection type: The Atherosclerosis Risk in Communities study (ARIC).International journal of cardiology · 2021Article
- A Rare Cause of ST-Segment Elevation Myocardial Infarction in COVID-19: MINOCA Syndrome.Medeniyet medical journal · 2021Article
- The Weight of Evidence From Electrophysiology, Observational, and Cardiovascular End Point Studies Demonstrates the Safety of Azithromycin.Clinical and translational science · 2021Review
- ECG Abnormalities in Patients with Acute Exacerbation of Bronchiectasis and Factors Associated with High Probability of Abnormality.Pulmonary medicine · 2021Observational
- Serious cardiovascular adverse events with fluoroquinolones versus other antibiotics: A self-controlled case series analysis.Pharmacology research & perspectives · 2020Observational
- Community-Acquired Pneumonia and Risk of Cardiovascular Events in People Living With HIV.Journal of the American Heart Association · 2020Observational
- Article
- The Cardiovascular Effects of Treatment with Hydroxychloroquine and Azithromycin.Pharmacotherapy · 2020Article
- Review
- Update on the adverse effects of antimicrobial therapies in community practice.Canadian family physician Medecin de famille canadien · 2020Review
- Article
Corrections and comments
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
Abstract
backgroundSome studies have found that antimicrobials, especially macrolides, increase the risk of cardiovascular death. We investigated potential cardiac-related events associated with antimicrobial use in a population of patients with acute myocardial infarction. METHODS AND
resultsFor 185 010 Medicare beneficiaries, we recorded prescriptions for azithromycin, clarithromycin, levofloxacin, moxifloxacin, doxycycline, and amoxicillin-clavulanate. In the following week, we recorded death, acute myocardial infarction, atrial fibrillation or atrial flutter, a non-atrial fibrillation/atrial flutter arrhythmia, or ventricular arrhythmia. We fit unadjusted and adjusted logistic regression models using generalized estimating equations. Adjusted models included patients' comorbidities, medications, procedures, demographics, insurance status, time since index acute myocardial infarction, number of visits, and the influenza rate. In unadjusted analyses, macrolides and fluoroquinolones were associated with a risk of cardiac events. However, the risk associated with macrolide use was substantially attenuated after adjustment for a wide range of variables, and the risk associated with fluoroquinolones was no longer statistically significant. For example, for azithromycin, the odds ratio for any cardiac event or death was 1.35 (95% confidence interval, 1.27-1.44;
conclusionsControlling for covariates explains much of the adverse cardiac risk associated with antimicrobial use found in other studies. Most antimicrobials are not associated with risk of cardiac events, and others, specifically azithromycin and clarithromycin, may pose a small risk of certain cardiac events. However, the modest potential risks attributable to these antimicrobials must be weighed against the drugs' considerable and immediate benefits.
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Registered trials
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