Azithromycin and Sensorineural Hearing Loss in Adults: A Retrospective Cohort Study. Issue 8 (September 2018)

• Record Type: Journal Article
• Authors: Alrwisan, Adel; Antonelli, Patrick J.; Brumback, Babette A.; Wei, Yu-Jung; Winterstein, Almut G.
• Is Part Of: Otology & neurotology. Volume 39:Issue 8(2018)
• Publication Date: 2018-09
• Subjects: Azithromycin -- Hearing loss -- Observational study -- Sensorineural hearing loss; Otology -- Periodicals; Ear -- Diseases -- Periodicals; Skull base -- Surgery -- Periodicals; 617.8005
• DOI: 10.1097/MAO.0000000000001887
• Languages: English
• ISSNs: 1531-7129

Abstract

Abstract : Objective: To examine whether short-term use of azithromycin increases the risk of sensorineural hearing loss (SNHL) in adults with uncomplicated infections. Study Design: A retrospective cohort study using Medicaid claims data, 1999 to 2010. Patients: Adults (18–64 years old) who had continuous enrollment in Medicaid for the 12 months (baseline) before the date of first dispensation (index date) of oral azithromycin or amoxicillin ± clavulanate for uncomplicated infections. Main Outcome Definition: We operationalized sensorineural hearing loss (SNHL) by a charge for audiometry and followed by a diagnosis of SNHL within 30 days. Analysis: We adjusted for the baseline covariates through propensity score matching. Adults were followed for up to 120 days after the index date. The hazard of SNHL in azithromycin-exposed adults was compared with those who had amoxicillin ± clavulanate using a Cox proportional hazard model. We performed several sensitivity analyses by varying the follow-up time, SNHL definition, adjusting for cumulative antibiotic use, and switching exposure status during the follow-up period. Results: A total of 493, 774 patients entered the study cohort. The unadjusted incidence rates of SNHL were 38 and 41 cases per 10, 000 patient-years following exposure to azithromycin and amoxicillin ± clavulanate, respectively. The adjusted (matched) hazard ratio (HR) of SNHL for azithromycin versus amoxicillin ± clavulanate was 0.91 (95% confidence interval [CI], 0.77–1.07). The sensitivity analyses findings were consistent with the primary analysis. Conclusion: Azithromycin short-term use was not associated with an increased risk of SNHL in comparison to amoxicillin ± clavulanate. Abstract : Supplemental Digital Content is available in the text