Short-term use of clarithromycin in lower respiratory tract infections may increase long-term risk of cardiovascular mortality and morbidity

摘要

Macrolides are commonly prescribed for chronic obstructive pulmonary disease (COPD) exacerbations and community-acquired pneumonia. The short-term cardiovascular effects, probably due to QT prolongation, are well documented and some studies have implicated macrolides with increased mortality in patients with pre-existing coronary disease. This study evaluated the association between clarithromycin use and cardiovascular events in patients treated for lower respiratory tract infections in a secondary analysis of two prospective cohort studies. The EXODUS dataset enrolled 1343 patients aged over 40 admitted with COPD exacerbations to 12 hospitals in the UK from 2009 to 2011. The Edinburgh pneumonia cohort included 1631 patients admitted to hospital with radiologically confirmed community-acquired pneumonia from 2005 to 2009. Both datasets were reviewed for cardiovascular events at 1 year (defined as hospital admission for acute coronary syndrome, decom-pensated cardiac failure, serious arrhythmia or sudden cardiac death). There were 268 events in the COPD cohort and 171 in the pneumonia cohort.