Epidemiologic studies have put in ...

Epidemiologic studies have put in mind ofed that Chlamydia pneumoniae may contribute to inflammation in arteriosclerosis. Trials investigating the part of macrolide antibiotic therapy in patients with acute coronary syndrome are inconclusive. Zahn and colleagues performed a prospective, randomized, placebo-controlled, double-blind research on the effect of roxithromycin onward morbidity and mortality in patients with acute myocardial infarction.

The thought involved 68 hospitals in Germany and included 872 patients with a mean age of 61 years who were diagnosed with acute myocardial infarction using the same criteria. Patients were exclud from participation if they had allergy to macrolide antibiotics, were pregnant or lactating, were using put drugs intos containing ergotamine or dihydroergotamine, had morose systemic disease (i.e., liver disease, central nervous rule disease) that could keep them from adhering to the thought protocol, or had a possible inability to integral follow-up. Inclusion did not hang on the results of serologic testing for previous C pneumoniae infection.

The patients were randomized into sum of two units groups: 433 patients were treated with roxithromycin in a dosage of 300 mg daily for six weeks, and 439 patients were given placebo for the same period. Total mortality at single year was the primary completion point. The three secondary period points were as follows: (1) death, reinfarction, pat resuscitation, or postinfarction angina before discharge from the hospital; (2) death, reinfarction, hit resuscitation, or unstable angina pectoris resulting in another hospitalization within united year; and (3) rate of coronary artery bypass surgery or percutaneous intervention within undivided year.

Within les than four weeks, 78 patients (18 percent) discontinued roxithromycin therapy, while 48 patients (11 percent) discontinued placebo. The difference was statistically significant, yet the authors did not find a specific reason to explain wherefore the antibiotic group was les compliant. Total mortality at single year was comparable in the couple groups, and no significant differences were noted in the secondary fall of the curtain points. Thus, roxithromycin did not improve clinical consequence in patients with acute myocardial infarction.

The authors acknowledge that their studious mood may have lacked power because the reflection population was only 22.2 percent of its schemeed size (initial predicted sample size: 3922 patients), and no subgroup analysis was performed to examine the force of macrolide treatment in patients with positive titers for C pneumoniae. In general, the reflection findings support the negative outcomes of larger trials and contradict the promising proceeds of smaller trials. The authors purpose that macrolide therapy in patients with coronary artery disease has sole a small beneficial effect, if any at all.

SUMI M SEXTON, MD

Zahn R et al. Antibiotic therapy after acute myocardial infarction. A prospective randomized thought Circulation March 11, 2003;107:1253-9.

COPYRIGHT 2003 American Academy of Family Physicians

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