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:
Interesting article from The NY Times by Dr. Zitter who is board certified in critical care medicine and palliative care. She discusses using a “patient-centered” checklist to confirm the proper surrogate decision maker. Check out the link below!
Today Dr. Elizabeth Maher gave a fantastic talk on the current clinical management and her research on brain metastases. She gave a great summary of the current guidelines for the management of brain mets by the The American Society of Radiation Oncology outlined below:
1. Single brain mets, larger than 3-4 cm, amenable to surgery with good prognosis (survival >3 months) –> Surgical reserction and WBRT (level 1 evidence). If smaller than 3-4 cm consider radiosurgery alone or WBRT and radiosurgery. If non resectable single brain met, WBRT can be considered (level 3)
2. Multiple brain mets and good prognosis (survival < 3 months) –> Radiosurgery + WBRT, Radiosurgery alone or WBRT alone can be considered (level 3)
3. Patients with poor prognosis (survival < 3 months) and single or multiple brain mets –> Palliative care +/- WBRT (level 3)
During her talk she also referenced a recent publication by our own Chair of Internal Medicine, Dr. David Johnson. Read his article here:
Very interesting article from The New York Times about Project ECHO which combines video teleconferencing and training from specialists that equip primary care providers with the knowledge to take care of complex patients. For example, a family medicine doctor treating a patient’s hepatitis C with antiviral therapy with the guidance of liver specialists remotely because the patient lives too far from the liver clinic. Check out the article below:
This week at morning report we discussed about the increasing prevalence of multi-drug resistant organisms making it harder for clinicians to treat patients with severe infections. In the most recent issue of The New England Journal of Medicine, a trial was published that looked at once a week dosing versus daily dosing of antibiotics for skin infections. Click on the link below to read the article!