Dr. Eric Mortensen is an Associate Professor of Internal Medicine and Clinical Sciences and Chief of General Internal Medicine at the VA North Texas Health Care System. He recently published an original article titled, “Association of Azithromycin with Mortality and Cardiovascular Events Among Older Patients Hospitalized with Pneumonia” in JAMA earlier this month.
Q: Why were you interested in looking at azithromycin and cardiovascular outcomes?
EM: There was a recent paper in NEJM (New England Journal of Medicine) that examined the association of azithromycin with cardiovascular mortality in Tennessee Medicaid patients, which demonstrated a small but significant increase in cardiac deaths with azithromycin use. As azithromycin is part of national practice guideline-concordant antibiotic therapy for pneumonia we wanted to see if this was true for those with pneumonia.
Q: In short, what were the main findings from your study and were any of these surprising?
EM: We found that azithromycin use was associated with decreased mortality within 90-days for those with pneumonia but a small increase in the MI (myocardial infarction) rate. Our take home message was that for every non-fatal MI caused by azithromycin there were 7 deaths that were avoided. Therefore we continue to recommend the use of azithromycin for patients with pneumonia.
Q: What kind of discussions do you hope your study triggers in the medical community?
EM: That studies of medications, especially drug safety, take context into account. The article in NEJM was probably largely those who had no appropriate indication for any antibiotic so they were being put at risk of cardiac death since there was no real benefit that could be expected from the use of antibiotics. In a condition, such as pneumonia, where there is significant mortality this antibiotic is one of the preferred one even though it slightly increases the risk of MI.
Q: Any advice to our housestaff who are interested in research? Particularly in outcomes research?
EM: If you are interested just start talking to people. I became interested in research when I was an IM resident at Pittsburgh. I made an appointment to meet with one of the internationally known faculty there who became my mentor and got me involved in his research.
Check out Dr. Mortensen’s published paper below: