Lessons About the Z-pak

Azithromycin seemed the perfect antibiotic: It worked on most respiratory bugs, was easy to take, rarely caused allergic reactions, and seemed less overkill than reaching for “broad spectrum antibiotics”.

It is often prescribed for typical viral infections, where it is not indicated, because of patient demands for something to “prevent pneumonia” or physician concern over missing an “atypical pneumonia” like mycoplasma.

There were early reports of sudden death in older patients from prolonged QT interval related arrhythmias, but no official FDA warnings until a decade later.

The other antibiotic we reach for with atypical pneumonias, Levaquin, has even more risk for QT prolongation, but that one is handled with more respect than the ubiquitous Z-pak.

The Annals of Family Medicine has a recent nice article about this:

“Risks and benefits of antibacterial therapies should be considered when making prescription decisions. As compared with amoxicillin, there was higher risk of death associated with azithromycin therapy administered to US veterans. 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.”


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