Houman Farzin, MD; Mai Takematsu, MD; Robert S. Hoffman, MD
Potential Conflicts of Interest: None disclosed.
Farzin H., Takematsu M., Hoffman R.; Statin Toxicity From Macrolide Antibiotic Coprescription. Ann Intern Med. 2013;159: 574-575. doi: 10.7326/0003-4819-159-8-201310150-00017
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Published: Ann Intern Med. 2013;159(8): 574-575.
TO THE EDITOR:
We read Patel and colleagues’ study (1) assessing statin toxicity and concomitant macrolide antibiotic prescription with interest. Although we commend the authors for performing this much-needed study, we have several concerns about the study design and interpretation of the results.
The investigators attempted to control for the cytochrome P450 isoenzyme 3A4 (CYP3A4)–inhibiting macrolides with azithromycin, stating that this agent has indications and patterns of clinical use similar to those of clarithromycin and erythromycin. Given the fact that the actual indications for antibiotic use are unknown in more than half of the participants, we believe that this comparison is fundamentally flawed, because the type, location, or severity of the infection could have affected the choice of antibiotic prescribed. In addition, the choice of azithromycin as the intervention in the comparison group implies that the investigators assumed that the increased risks were due to CYP3A4 metabolism. Inclusion of a nondrug comparison group would have addressed these concerns.
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