The risk of cardiovascular death associated with macrolide antibiotic use for acute lung injury

Abstract

Macrolide antibiotics have recently raised a concern for patients with acute lung injury (ALI). The work by Walkey et al. reported that use of macrolide antibiotics was associated with lower 180-day mortality and shorter time to successful discontinuation of mechanical ventilation in patients with ALI [1]. As we know, macrolide antibiotics have a pulmonary anti-inflammatory action beyond their antimicrobial activity and have a potential clinical benefit in chronic lung diseases [2,3]. Besides, macrolide antibiotics may protect some septic patients with coronary artery disease from acute myocardial infarction which contributes to the reduction of cardiac mortality as well [4]. However, according to a recent study by Ray et al., use of azithromycin, one of macrolide antibiotics increases risk of cardiovascular death for patients without severe pneumonia and sepsis requiring mechanical ventilation, within the initial 5-day period [5]. Although azithromycin is thought to have less cardiac toxicity than other macrolide antibiotics, Ray et al. found that sudden cardiac death and lethal arrhythmia rather than acute myocardial infarction accounted for the majority of cardiovascular deaths for a 10-day observation. Therefore, use of macrolide antibiotics is like a double-edged sword and survival benefits have to be weighed against cardiovascular hazards in patients with ALI. The intensive care physicians should cautiously use macrolide for thosewhohave a past history of sudden cardiac death and organic heart disease such as dilated cardiomyopathy, myocarditis, depressed left ventricular ejection fraction and prolonged QT syndrome especially in the initial use period. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology.