Background: Azithromycin is one of two CDC-recommended therapies for the treatment of chlamydia (CT) and is recommended as part of the gonorrhea (GC) treatment regimen. In one study, azithromycin was associated with sudden cardiac death but this was not confirmed in another study. This has not been examined among typically healthy persons with GC and CT.
Methods: We identified all cases of GC and CT reported in Oregon from 1996-2012 and in King County, Washington State from 1993-2010. Among cases who received treatment, we matched case report data to location-specific death record data in the same time period to enumerate cases that died within 10 days of treatment. We report the risk of cardiovascular and all-cause mortality among cases treated with azithromycin compared to another drug.
Results: There were 269,179 reported cases of GC and CT in Oregon and King County during the study period. Of these, 260,048 (97%) had complete treatment information and were included in the analysis. The mean age of included cases was 24 (SD=8), 65% were female, and 84% had CT. Sixty-two percent (n=162,238) were treated with azithromycin; among the 97,663 not treated with azithromycin, the majority (77%) received a tetracycline. We identified no cardiovascular deaths among cases treated with azithromycin (risk=0.0 deaths, 95% CI=0.0-18.5 per 1 million doses), and none among cases treated with another therapy (risk=0.0 deaths, 95% CI=0.0-30.7 per 1 million doses). There were 3 non-cardiovascular deaths (risk=18.5 deaths per 1 million doses) among azithromycin-treated cases and 2 (risk=20.5 deaths per 1 million doses) among cases treated with another therapy (RR=0.90, 95% CI=0.15-5.40). These 5 deaths were attributed to suicide (n=2), homicide (n=1), drug overdose (n=1) and rectal cancer (n=1).
Conclusions: These results suggest that azithromycin is not associated with an increased risk of cardiovascular death among treated persons with GC and CT.