新数据: 阿奇霉素、左氧氟沙星和心血管疾病的风险
翻译：陈都 校对：肖锋

Title: New Data: Azithromycin and Levofloxacin and Cardiovascular Risk
题目：新数据: 阿奇霉素、左氧氟沙星和心血管疾病的风险
Author 作者: Bryan Hayes

A new study of almost 2 million prescriptions in VA patients compared the risk of cardiovascular death or dysrhythmia in patients receiving azithromycin, levofloxacin, and amoxicillin.
在一项新的包含近200万份室颤患者处方的研究中，比较了使用阿奇霉素、左氧氟沙星和阿莫西林患者心血管死亡和心律失常的风险。
What they found
他们发现
Compared with amoxicillin, azithromycin resulted in a significant increase in mortality (HR = 1.48; 95% CI, 1.05-2.09) and dysrhythmia risk (HR = 1.77; 95% CI, 1.20-2.62) on days 1 to 5, but not 6 to 10.
与阿莫西林相比，阿奇霉素使第一天到第五天的死亡(HR = 1.48; 95% CI, 1.05-2.09) 和心律失常(HR = 1.77; 95% CI, 1.20-2.62) 风险显著增加（第六天到第十天不明显）。
Levofloxacin resulted in an increased risk throughout the 10-day period. Days 1-5 mortality (HR = 2.49, 95% CI, 1.7-3.64) and serious cardiac dysrhythmia (HR = 2.43, 95% CI, 1.56-3.79). Days 6-10 mortality (HR = 1.95, 95% CI, 1.32-2.88) and dysrhythmia (HR = 1.75; 95% CI, 1.09-2.82).
左氧氟沙星则可以引起整个十天内不良风险的增加。第一天到第五天的死亡和严重心律失常风险分别为： HR = 2.49, 95% CI, 1.7-3.64; HR = 2.43, 95% CI, 1.56-3.79。第六天到第十天的死亡和心律失常风险分别为：HR = 1.95, 95% CI, 1.32-2.88; HR = 1.75; 95% CI, 1.09-2.82。
Important limitations
值得注意的局限性
This study did not have a comparator group of patients getting no antibiotics. Previous data suggest patients on any antibiotic (eg, penicillin) have a higher risk of death or dysrhythmia.
该研究没有设置未服用抗生素的对照组。以前的研究数据表明，接受任何抗生素（比如青霉素）治疗的患者其死亡和心律失常的风险都高。
The supplemental index shows that patients receiving azithromycin and levofloxacin had more serious infections (eg, PNA, COPD, etc.) which may have put them at higher risk for worse outcome irrespective of antibiotic choice.
补充的数据显示接受阿奇霉素和左氧氟沙星治疗的患者有较严重的感染（如PNA, COPD等），这将使其不管选用何种抗生素，最终出现不良预后的风险更高。
What it means
启示
It seems azithromycin and levofloxacin do contribute to a small increase in cardiovascular mortality and dysrhythmia during their use. A previous study found this is more likely in those with existing cardiovascular disease.
阿奇霉素和左氧氟沙星的使用的确会导致心血管死亡和心律失常发生率的小幅增加。之前的一个研究发现，这种情况更多发生在合并心血管疾病的患者中。
References 参考文献
Rao GA, et al. Azithromyicin and levofloxacin use and increased risk of cardiac arrhythmia and death. Ann Fam Med 2014;12(2):121-7. [PMID 24615307]