Zithromax Z-Pak (azithromycin) and heart meds

I am concerned about possible drug interactions between the antibiotic azithromycin and the two heart medications warfarin and amiodarone. My relative has brief history of heart problems span one and a half years (though the underlying heart condition itself appears to be congenital). Rhythm problems resulted in CHF, hospitalization, and later diagnosis and heart surgery. Subsequent dysrhythmia and CHF has been prevented adequately with medication.

This relative recently went to the doctor complaining of a very bad soar throat. They received flu shots earlier this year, and no signs of strep throat seem visually present. I personally suspect a cold. If it is in fact viral, the doctor wants to use azithromycin now to prevent possible respiratory infection or bronchitis.

I have found a substantial amount of literature online that discusses how using azithromycin with QT prolonging drugs or other rhythm regulators can increase the QT interval and cause dysrhythmia. This relative was in the hospital before and after surgery due to rhythm problems. It took a while to adjust exercise and meds to balance everything out. More than any other antiobiotic I read up on, azithromycin seems to have the most solid arguments against using it with drugs like amiodarone. I am quite concerned about this causing new dysrhythmia. I have also read that this and other antiobiotics can increase bleeding risks if used with warfarin.

Are there any antiobiotics that are effective with respiratory ailments that are documented as being generally safe to use with meds like amiodarone and warfarin?

[Bromley]

This looks to me to be a valid concern. However, as most of us here are not medical doctors,  we would probably be inclined to stop short of recommending anything countermand to your doctor's treatment plan. I would consider stepping back from this and asking yourself what are the most effective actions you can take to assist with the problem solution. In my opinion, possible appropriate actions would include:
- ensuring that you have correctly communicated your concerns, and the patients history, to the doctor in charge of your relative's care. I think I would also ask for an explanation and without being judgmental (at least initially) see what comes back. If communication with your doctor is difficult, try working through his RN.
- working to obtain  a second opinion if you have doubts about the medical are you are receiving. Then changing doctors and medical treatments, as recommended by a doctor, if necessary.

I am sorry to hear that someone you care about is having problems. They are obviously fortunate to have an intelligent and concerned relative watching out for them.  Stick with this. You are doing the right thing.

[is_something_wrong]

I would definitely get a second opinion from someone that specializes in internal medicine or cardiology.

From what I know (I'm no expert and certainly not a doctor), Warfarin (I assume you have atrial fibrillation) doesn't increase the QT interval but amiodarone does. What is important, is that your QT interval is measured (with EKG) to determine if it's prolonged or not. Azithromycin is, along with erythromycin and clarithromycin, antibiotics that may prolong the QT interval.

They are usually used agains two specific infections that can't be treated with normal antibiotics; chlamydia (both the STD and the lung infection, though they have nothing to do with each other) and mycoplasma pneumonia. I believe this type of antibiotics are named macrolid antibiotics (roughly translated from my language).

Tetracyclin works against the mentioned infections and I don't think it causes prolonged QT.

Your concern is real, but I would assume your doctor would have considered this. Anyway, ask him.

[Madge270]

I wish I could take antibiotics. Most close  my throat. I can still use clindamycin without an allergic reaction (at least for now), but I'm now wondering whether that affects heart arrhythmia.

Thanks for the heads up.