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

(1) Based on an attractive hypothesis implicating inflammation caused by Chlamydia pneumoniae in cardiovascular disease, several clinical trials have tested whether antibiotic therapy has a long-term preventive effect. (2) One trial showed an increase in mortality 3 years after a 2-week course of clarithromycin in patients with coronary heart disease (9.8% versus 7.8% in the placebo group). This difference resulted mainly from higher cardiovascular mortality (5.1% versus 3.5%). (3) A meta-analysis of all trials of antichlamydial antibiotics (mainly macrolides) in the prevention of cardiac events showed no difference between the groups in terms of cardiac morbidity or mortality. However, trials with more than 2 years of follow-up suggest that antimicrobial chemotherapy is associated with a statistically significant increase in mortality. (4) In practice, pending further information on the long-term effects of antimicrobial chemotherapy in coronary heart disease patients, these disturbing results suggest that the drugs are best avoided--especially macrolides--except in situations where their use is clearly warranted.

PMID: 17167932 [PubMed - indexed for MEDLINE]