YOUR MEDICAL MOMENT: Z-PAKS

30 Mar YOUR MEDICAL MOMENT: Z-PAKS

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Laura Cattell, PA-C

Laura A. Cattell, PA-C answer this week’s question:

SHOULD I TAKE A Z-PAK?

A recent study published in the New England Journal of Medicine has brought a lot of attention to a very popular antibiotic: azithromycin commonly referred to as the Z-pack.  This is a very frequently prescribed medication as it treats bacterial infections that can cause common upper respiratory symptoms including strep throat, ear infections and bronchitis. Z-packs are easy to take; compliance is high with dosing just once a day for 5 days. Both patients and providers find it convenient.

The study performed was a retrospective study of patients prescribed certain antibiotics and reviewed the incidence of death, specifically cardiovascular deaths. What the researchers found is a very slight increased risk of death for people taking a 5-day course of azithromycin, compared to people prescribed amoxicillin or no antibiotic. The most common cause of death was cardiovascular in nature. Data suggests that azithromycin has a “pro arrhythmic effect” increasing the QT interval (a measure of the time between the start of the Q wave and the end of the T wave in the heart’s electrical cycle) of the electrical activity of the heart, which can then lead to a change in the rhythm of the heart and possibly death.

What does this mean to the average patient?

When the researchers compiled all the data it showed an absolute increase of 22 sudden cardiac deaths in the group of people taking azithromycin, which translated to 65 sudden cardiac deaths per million people prescribed a Z-pack.  This is significantly higher then in the control groups, which were 24 deaths per million when no antibiotics were prescribed and 22 deaths per million when amoxicillin was prescribed. Upon further examination, rate of death was much higher in patients with increased cardiac risk factors; these high risk patients accounted for 60% of all cardiovascular deaths associated with the Z-pack and had an estimated 245 cardiac death per million people.

The bottom line: if you are a healthy fit individual with no history of cardiovascular disease, significant risk factors for heart disease and not taking a medication for an arrhythmia or a medicine that can prolong your QT interval, you are probably OK to take the Z-pack.

If you suspect you need antibiotics, please bring a list of your medications to your appointment as there are different medications that can prolong the QT interval and it is best to check with your provider. And always tell your provider of any history of cardiac issues.

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