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Year : 2014  |  Volume : 5  |  Issue : 1  |  Page : 71-72  

Antibiotics with a curse of cardiovascular risk


Date of Web Publication7-Jan-2014

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How to cite this article:
. Antibiotics with a curse of cardiovascular risk. J Pharmacol Pharmacother 2014;5:71-2

How to cite this URL:
. Antibiotics with a curse of cardiovascular risk. J Pharmacol Pharmacother [serial online] 2014 [cited 2019 Oct 22];5:71-2. Available from: http://www.jpharmacol.com/text.asp?2014/5/1/71/124432


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In a first of its kind study, use of the macrolide clarithromycin has been found to be associated with increased risk for CV events in patients with exacerbations of chronic obstructive pulmonary disease (COPD) or community-acquired pneumonia. [1]


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Lung disease and CV risk

Community-acquired pneumonia [2] and exacerbation of COPD [3] have per se been reported to be associated with an increased risk of CV (myocardial infarction) and vascular (stroke) events. It has been suggested that that the inflammatory state in infected patients promote platelet activation and thrombosis, destabilise vascular endothelium leading to an imbalance between myocardial oxygen supply and demand.

Antibiotic drugs and CV risk

A significantly higher CV mortality from short term (2 weeks) clarithromycin use in patients with stable coronary heart disease [4] and long term CV risks associated with macrolides [5],[6] use have been reported. Clarithromycin's pro-arrhythmic effects mediated through prolongation of the QT interval is also well known.

Disease, drug and CV risk

Not surprisingly, as a synergistic effect, the combination of the two disease (disease-COPD, community-acquired pneuminia and drug-clarithromycin) has been reported with a possible association with increased CV events. [7]

The same study also suggests that use of β lactam antibiotics or doxycycline was not associated with increased CV events. [7]

A recent study has raised that there are evidence-based concerns for cardiotoxicity with azithromycin and that the idea that azithromycin is essentially safe with regard to cardiac events is no longer valid. [8]

 
   References Top

1.Available from: http://firstwatch.jwatch.org/cgi/content/full/2013/322/2. [Last accessed on 2013 May 13].  Back to cited text no. 1
    
2.Singanayagam A, Singanayagam A, Elder DH, Chalmers JD. Is community-acquired pneumonia an independent risk factor for cardiovascular disease? Eur Respir J 2012;39:187-96.  Back to cited text no. 2
    
3.Donaldson GC, Hurst JR, Smith CJ, Hubbard RB, Wedzicha JA. Increased risk of myocardial infarction and stroke following exacerbation of COPD. Chest 2010;137:1091-7.  Back to cited text no. 3
    
4.Jespersen CM, Als-Nielsen B, Damgaard M, Hansen JF, Hansen S, Helø OH, et al. Randomised placebo controlled multicentre trial to assess short term clarithromycin for patients with stable coronary heart disease: CLARICOR trial. BMJ 2006;332:22-7.  Back to cited text no. 4
    
5.White AJ, Gompertz S, Stockley RA. Chronic obstructive pulmonary disease. 6: The aetiology of exacerbations of chronic obstructive pulmonary disease. ThoraX2003;58:73-80.  Back to cited text no. 5
    
6.Restrepo MI, Mortensen EM, Waterer GW, Wunderink RG, Coalson JJ, Anzueto A. Impact of macrolide therapy on mortality for patients with severe sepsis due to pneumonia. Eur Respir J 2009;33:153-9.  Back to cited text no. 6
    
7.Schembri S, Williamson PA, Short PM, Singanayagam A, Akram A, Taylor J, et al. Cardiovascular events after clarithromycin use in lower respiratory tract infections: Analysis of two prospective cohort studies. BMJ 2013;346:f1235.  Back to cited text no. 7
    
8.Ray WA, Murray KT, Hall K, Arbogast PG, Stein CM. Azithromycin and the risk of cardiovascular death. N Engl J Med 2012;366:1881-90.  Back to cited text no. 8
    




 

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