Cardiovascular Risks with Azithromycin

To the Editor: Neither the article by Svanström et al. (May 2 issue)¹ nor the related Perspective article by Mosholder et al.² cites any randomized, controlled trials of azithromycin in coronary heart disease. In a meta-analysis of these studies (involving 13,778 patients and approximately 700 deaths) the odds ratio for death associated with azithromycin versus placebo was 0.91 (95% confidence interval [CI], 0.77 to 1.09; P=0.31).^3,4 In the study by Ray et al. involving Medicaid beneficiaries, there were 79 deaths among patients who received no antibiotics (1,391,180 control periods), 70 deaths among patients who received amoxicillin (1,348,672 prescriptions), and . . .