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Clarithromycin in coronary heart disease: excess mortality in the long term

    Prescrire International
    |December 16, 2006
    PubMed

    Insights

    Antibiotic therapy for Chlamydia pneumoniae in cardiovascular disease patients showed no benefit and may increase mortality. Further research is needed, but macrolides should be avoided in most cases.

    Area of Science:

    • Cardiology
    • Infectious Diseases
    • Pharmacology

    Background:

    • Inflammation from Chlamydia pneumoniae is hypothesized to contribute to cardiovascular disease.
    • Clinical trials have investigated antichlamydial antibiotic therapy for cardiovascular disease prevention.

    Purpose of the Study:

    • To evaluate the long-term preventive effects of antibiotic therapy on cardiovascular events.
    • To assess the impact of antichlamydial antibiotics on mortality in coronary heart disease patients.

    Main Methods:

    • A meta-analysis of clinical trials using antichlamydial antibiotics (primarily macrolides).
    • Review of trial data, including mortality and cardiac event rates, with follow-up periods.

    Main Results:

    • One trial indicated increased mortality 3 years post-clarithromycin treatment for coronary heart disease.
    • Meta-analysis showed no reduction in cardiac morbidity or mortality.
    • Trials exceeding 2 years of follow-up suggest a significant increase in mortality with antimicrobial chemotherapy.

    Conclusions:

    • Current evidence does not support the use of antichlamydial antibiotics for cardiovascular disease prevention.
    • Long-term antimicrobial chemotherapy, particularly macrolides, may be associated with increased mortality in coronary heart disease patients.
    • Avoidance of these antibiotics is recommended unless clinically indicated, pending further data.

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