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Comment & Response
October 1, 2014

Azithromycin for Elderly Patients With Pneumonia—Reply

Author Affiliations
  • 1VA North Texas Health Care System, Dallas
  • 2Texas Tech University Health Sciences Center, Dallas
  • 3University of Texas Southwestern Medical Center, Dallas

Copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2014;312(13):1352-1353. doi:10.1001/jama.2014.10176

In Reply Regarding the concern of Dr Bin Abdulhak and colleagues about examining shorter periods than 10 days after admission, we consider follow-up durations longer than 5 days to be more clinically relevant and important. Although there may be an increased risk of arrhythmias earlier due to the use of azithromycin, we doubt that clinicians or patients would then avoid this medication when there is a clinically significant survival advantage at 90 days.

However, we have repeated our analyses for the outcomes of any cardiovascular events and all-cause mortality within 5 days of admission and found results similar to those at 10 days reported in our article. There was significantly improved mortality (odds ratio, 0.75; 95% CI, 0.69-0.72) and a small but significant increase in any cardiovascular event (odds ratio, 1.06; 95% CI, 1.03-1.09). Therefore, we are confident in our published conclusions.