Long-Term Risk of Cardiovascular Death with Use of Clarithromycin and Roxithromycin : A Nationwide Cohort Study

Inghammar, MalinLund University,Lunds universitet,Infektionsmedicin,Sektion III,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Infection Medicine (BMC),Section III,Department of Clinical Sciences, Lund,Faculty of Medicine,Danish Serum Institute, Copenhagen,Skåne University Hospital (författare)

Recent studies have raised concern that macrolide antibiotics may be associated with an increased long-term risk of cardiovascular death. We examined the 1-year risk associated with treatment with clarithromycin (n = 187,887) or roxithromycin (n = 698,899) compared with penicillin V (n = 3,473,081) matched 1:4 on propensity score, in a nationwide, registry-based cohort study in Danish outpatients, 1997-2011. Among clarithromycin courses, the rate ratio for cardiovascular death was 1.24 (95% confidence interval (CI): 0.96, 1.59). Among roxithromycin courses, the rate ratio was 0.99 (95% CI: 0.86, 1.16). In analyses by time after treatment start, the rate ratio associated with clarithromycin was 1.66 (95% CI: 0.98, 2.79) during days 0-7. This was attenuated in later time periods (days 8-89, rate ratio = 1.30, 95% CI: 0.88, 1.94; and days 90-364, rate ratio = 0.96, 95% CI: 0.63, 1.47). For roxithromycin, the rate ratios were 0.88 (95% CI: 0.59, 1.32) during days 0-7, 1.17 (95% CI: 0.92, 1.48) during days 8-89, and 0.88 (95% CI: 0.70, 1.10) during days 90-364. We found no increased risk of cardiovascular death in a general outpatient population. With clarithromycin, we observed a transient increased risk during days 0-7 after treatment start, which corresponds to the period of active treatment. This association was absent in later time periods, which is consistent with no long-term toxicity resulting in cardiovascular death.

Nibell, OlofLund University,Lunds universitet,Infektionsmedicin,Sektion III,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Infection Medicine (BMC),Section III,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital,Danish Serum Institute, Copenhagen(Swepub:lu)med-onb (författare)
Pasternak, BjörnKarolinska Institutet,Karolinska Institute,Danish Serum Institute, Copenhagen(Swepub:lu)extLU-33 (författare)
Melbye, MadsStanford University,Danish Serum Institute, Copenhagen (författare)
Svanström, HenrikDanish Serum Institute, Copenhagen (författare)
Hviid, AndersDanish Serum Institute, Copenhagen (författare)
InfektionsmedicinSektion III (creator_code:org_t)

Ingår i:American Journal of Epidemiology: Oxford University Press (OUP)187:4, s. 777-7850002-92621476-6256

Av författaren/redakt...: Inghammar, Malin; Nibell, Olof; Pasternak, Björn; Melbye, Mads; Svanström, Henri ...; Hviid, Anders

Om ämnet

MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kardiologi

MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Hälsovetenskap; och Folkhälsovetensk ...

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