To Z or Not to Z: Exploring the Antibiotic Question - A close up of a fruit - Vanderbilt University Medical Center

by Dr. Stanley Sack 

Here in the Keys, we may not have easy access to a Wal-Mart. But one thing we do have available to us, at least on days when our communication devices are working properly, is breaking news. When the news contains items about potential health hazards, we get concerned.

Such was the case back in 2012, when researchers found an increased risk of death due to heart disease from the antibiotic azithromycin. Best known by the brand name Zithromax, azithromycin has been a popular choice for years among patients and doctors for a variety of infections, largely due to its ease of dosing. With its schedule of once a day for five days, what adult among us has not been on a “Z-pack” from time to time? And we pediatricians are very familiar with its use in children: in some diseases such as whooping cough, it’s often a first choice.

This, um, “Z-eal” for the drug was dampened a little bit by that 2012 study, which found an increase in cardiac death in adults taking azithromycin compared to antibiotics such as amoxicillin. Fortunately, there have been additional studies since that time that have failed to show this increase. On the other hand, other research has found that drugs in the azithromycin family (including its older cousin, erythromycin) can cause heart rhythm problems—also commonly known as “arrhythmia,” or abnormal heartbeat.

So we have this incredibly convenient antibiotic with few side effects in most people. But despite these reassuring recent studies, you may still be concerned about azithromycin. What’s an infected person to do?

I’d answer this question pretty much the same way no matter what antibiotic we were talking about. It’s most important to realize that antibiotics treat bacterial infections. As Key West pediatrician Dr. Melanie Youschak notes: “Antibiotics are wonderful when used appropriately. They are strong ammunition against the right target. However, when used inappropriately for a non-bacterial infection, like the common cold, they have no benefit and carry a risk of side effects.”

Thus, have that conversation with your provider. Is an antibiotic the best treatment? Or will chicken soup do the trick? It’s also important to know what your provider is treating, what good the medicine will do, and what the risks are. Again, there is some risk with anything we take. We just try and choose meds where the risk is pretty minor compared to the benefit.

Finally, and especially in this era of “Dr. Right Now,” who may not know your health history, remember to share any past medical problems with your provider! You may already know to talk about any allergies you have to medications. In case of azithromycin, physicians may think twice about using the drug in patients who already have the tendency toward certain heart rhythm problems. If we don’t tell, they don’t know.

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