Marc Siegel, MD
We have a problem with antibiotic overuse in the U.S. that leads to resistant bacteria as well as unnecessary side effects. When you consider that over 90% of upper respiratory infections and sinus infections are viral, it is clear that too many doctors and their patients are reaching for the easy Zpack, where you only have to take one pill a day for five days. For millions, the antibiotic is well tolerated, though most physicians realize that they are mostly administering placebo. Then the FDA decided out of the blue to warn the American public that the drug (generic name azithromycin) has the potential for provoking a fatal heart rhythm, especially in those with a low heart rate, a rhythm disturbance to begin with, or a deficiency of certain electrolytes.
The news media decided to play its usual unappointed role of public educator, as usual failing to consider that the risk of anyone dying was extremely low (47 in a million courses of the drug), and that the information the new FDA statement was based on was almost a year old.
Patients are sure to run from Zithromax and reach for other antibiotics instead. The message that antibiotics are overused will soon be lost, shrouded in unnecessary fear of a single antibiotic as education gives way to the usual shock and awe. Of course many of these antibiotics have more common and concerning side effects than Zithromax does (quinolones including Levaquin and Cipro have been associated with tendon injury).
I am not saying that the FDA shouldn't have issued its statement, or that physicians shouldn't be reminded about the potential overuse of an antibiotic in a certain at risk group. But keep in mind that Zithromax is part of a group of antibiotics called macrolides (including the popular erythromycin) which have been known to have this rare potential side effect for decades.Zithromax is hardly the bad guy here. The bad guy is a doctor who overprescribes it or a news media which hyperbolizes a story like this to goose ratings.