Azithromycin and the Risk of Cardiovascular Death

To the Editor: Ray et al. (May 17 issue)¹ report findings from an observational retrospective study that must be placed into context with other available data. Two large, randomized, placebo-controlled trials involving 11,759 patients with stable coronary artery disease showed no increase in mortality with 600 mg of weekly azithromycin therapy for 3 or 12 months.^2,3 Azithromycin is a weak hERG (human ether-a-go-go–related gene) inhibitor, and, in several studies in animals, it lacked proarrhythmic activity above therapeutic concentrations.^4,5 No significant QT-interval prolongation was observed in clinical studies of various doses of intravenous azithromycin leading to drug plasma levels . . .