Nezam El-Tayebat Fact CheckA scientific assessment of the “نظام الطيبات” nutrition system
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Mostly true Certainty of evidence: low provisional C-ABX-08

A five-day course of azithromycin carried a 2.49-fold higher risk of cardiovascular death than amoxicillin, i.e. 47 extra deaths per million courses, and 245 per million in high-risk patients.

Conclusion: Correctly reported; small absolute, drug-specific risk.
  1. Original statement
  2. Scientific assessment
  3. In plain language
  4. Studies on this claim
  5. Regional context
  6. What applies in my country?
  7. References

Original statement

أظهر Ray في NEJM عام 2012 أن دورة من خمسة أيام من الأزيثرومايسين ترفع خطر الوفاة القلبية الوعائية بمعدل 2.49 مقارنة بالأموكسيسيلين

verbatim according to source. Translation by the project; the Arabic wording is authoritative.

Translation

A five-day course of azithromycin carried a 2.49-fold higher risk of cardiovascular death than amoxicillin, i.e. 47 extra deaths per million courses, and 245 per million in high-risk patients.

Origin

Source status
Archive editors
Attribution
Archive editors (eltayebat.com)
Origin
https://eltayebat.com/rule/antibiotic-overuse/
Attribution uncertainty
Archive editorial narrative and featured-study cards, written by the archive operators; study selection is the archive's, not necessarily Elawady's.
Claimed mechanism

QT prolongation/arrhythmia.

Claimed health effect

Cardiovascular death.

Population concerned

Adults (Tennessee Medicaid)

Geographic restriction by Elawady

none found

Scientific assessment

Mostly true – Correct at its core, but with limitations or minor inaccuracies.

Certainty of evidence: low – Further research is likely to change the assessment considerably.

1. What was claimed?

Azithromycin cardiac risk.

2. What is demonstrably correct?

HR 2.49 (1.38-4.50) vs amoxicillin; 47 additional CV deaths per million courses; 245 per million in the highest risk decile (A-ABX-13). The archive also reports the absolute numbers, which is good practice.

3. What is wrong or exaggerated?

Nothing misreported. It is a drug-specific risk, not evidence that antibiotics in general are dangerous.

4. What remains unclear?

Replication in other populations (not reviewed here).

5. Which studies support it?

A-ABX-13.

6. Which studies contradict it?

None reviewed; replication in other populations was not assessed here.

7. What applies to Germany and Europe?

The study is a US cohort (A-ABX-13); no European replication was reviewed.

8. What is known about Egypt?

No Egyptian data were reviewed.

9. What practical conclusion is appropriate?

Drug choice matters in patients with heart risk.

Assessment details

Rationale for certainty of evidence

Numbers correctly reported from a large observational cohort; single study read; absolute risk is small; residual confounding possible.

Source quality

High-quality pharmacoepidemiology (NEJM).

Regional transferability

Moderate.

Individual exceptions

Higher-risk patients have higher absolute risk.

Regional scope of the claim
not specified
Last reviewed
25 October 2026 provisional

In plain language

A large US study found that azithromycin was linked to a small extra risk of death from heart problems compared with amoxicillin: about 47 extra deaths per million treatment courses. In people with high heart risk it was about 245 per million. This is a known drug-specific risk that doctors consider when choosing an antibiotic.

Studies on this claim

Studies supporting the claim (1)

  • Azithromycin and heart deaths

    Ray WA et al.. N Engl J Med 2012 · PMID 22591294 · DOI 10.1056/NEJMoa1003833
    Cohort studycited by the Tayebat archivefull text checked★ key study

    Azithromycin was linked to about 47 extra heart deaths per million courses compared with amoxicillin.

    Does the study support the specific claim? Yes · Methodological quality: high · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    Test CV risk.

    How was the study done?

    Cohort.

    How many people, animals or samples were studied?

    347,795 azithromycin courses vs 1.39 million matched non-use periods and 1.35 million amoxicillin courses (Tennessee Medicaid, 1992-2006).

    What was actually found?

    CV deaths during 5 days: 85.2 per million azithromycin courses vs 31.5 per million amoxicillin courses; HR 2.49 (1.38-4.50) vs amoxicillin.

    How large was the observed effect?

    HR 2.49; +47/million.

    What do the results mean in everyday life?

    Rare but real for high-risk patients.

    What are the study's limitations?

    Observational; few deaths (29); Medicaid population; no difference from levofloxacin.

    What does it say about Elawady's specific claim?

    Supports.

    Do the results apply to Germany and Europe?

    Moderate.

    What can explicitly not be concluded from this study?

    That antibiotics are generally dangerous.

    Scientific details →

Studies contradicting or limiting the claim (0)

No studies in this group.

Studies with mixed or unclear results (0)

No studies in this group.

Regional context

Germany / EU

The study is a US cohort (A-ABX-13); no European replication was reviewed.

Egypt

No Egyptian data were reviewed.

What applies in my country?

General scientific assessment

Mostly true Correctly reported; small absolute, drug-specific risk.

This statement concerns biological or medical relationships. The scientific assessment above applies regardless of the country; country-specific food data do not change it.

References

  1. Azithromycin and the risk of cardiovascular death.. Ray WA et al.. N Engl J Med 2012 · PMID 22591294 · DOI 10.1056/NEJMoa1003833

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