Clinical Question: Does antibiotic ...

Clinical Question: Does antibiotic therapy hinder cardiovascular events in patients with heart disease?

Setting: Various (meta-analysis)

application of mind Design: Meta-analysis (randomized controlled trials)

Synopsis: The authors of this meta-analysis combined the inferences of nine randomized studies enrolling more than 11000 participants (mostly men) They identified these studies by means of searching MEDLINE and references of review articles. They included in their analysis merely articles written in English. The authors may have missed research findings: it is preferable to diocese a search of at least sum of two units databases, the inclusion of research in all languages, and a search for unpublished research. Their timing also may be poor: five large studies examining the part of antibiotic therapy in the prevention of cardiovascular circumstances in patients with heart disease generally are being conducted.

The studies the authors used recorded patients with known coronary heart disease who were treated with antibiotics regardless of the appearance of Chlamydia pneumoniae. In the various studies, patients were treated with placebo or a macrolide antibiotic--azithromycin, roxithromycin, or clarithromycin--for seven to 90 days. The results to be prevented were acute myocardial infarction, unstable angina, or unforeseen death. Individually, only one of the nine studies erect a benefit to treatment; when combined, there was no statistically significant reduction in the combined consequences or in mortality rates.

Bottom Line: In nine studies enrolling more than 11000 participants with coronary heart disease, antibiotic treatment with a macrolide did not decrease the likelihood of death or a coronary termination More studies currently are being bearinged in specific populations. (Level of Evidence: 1a)

contemplation Reference: Wells BJ, et al. Antibiotics for the secondary prevention of ischemic heart disease: a meta-analysis of randomized controll trials. Arch Intern M October 25 2004;164:2156-61

Used with permission from Shaughnessy AF. Antibiotics ineffective in preventing 2nd heart attack. Accessed online December 28 2004 at: http://www.InfoPOEMs.com.

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