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If you’ve ever had a bacterial infection like bronchitis, pneumonia, a sore throat, or an earache, your doctor likely prescribed azithromycin, commonly known as Z-pak. But a new study suggests the popular antibiotic may increase the odds of sudden death in adults, particularly in those with heart disease, diabetes, or those who’ve undergone bypass surgery.

Vanderbilt University professor of preventative medicine Wayne A. Ray and his team studied 540,000 Medicaid patients’ medical records in Tennessee between the ages of 30 and 74 over a 14-year period. Children were excluded because, the researchers said, they have little risk of heart disease. Patients who’d taken Z-pak were compared to those who'd been prescribed amoxicillin, ciprofloxacin and levofloxacin. The New York Times reports that, by comparing people who’d taken other antibiotics, “the researchers hoped to control for the possibility that the infections they were being treated for were the cause of sudden death.”

The researchers recorded 64.6 cardiovascular-related deaths per million in those patients who’d taken Z-pak. While the risk isn’t that much greater than those who’d taken the other medications, researchers said it’s a significant enough risk that doctors should consider prescribing another antibiotic for high-risk patients.

Doctors and patients like the fact that Z-pak only needs to be taken for five or 10 days, but professor of medicine at Johns Hopkins University School of Medicine and former president of the Infectious Diseases Society of America Dr. John G. Bartlett says doctors prescribe Z-pak too often. He says that by prescribing the potent Z-pak for colds and other viral infections that it doesn’t really treat, doctors have contributed to the formation of dangerous, drug-resistant strains of bacteria.

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