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Cardiovascular outcomes associated with use of clarithromycin: population based study

Wong, Angel Y.S.; Root, Adrian; Douglas, Ian J.; Chui, Celine S.L.; Chan, Esther W.; Weldeselassie, Yonas Ghebremichael; Siu, Chung-Wah; Smeeth, Liam and Wong, Ian C.K. (2016). Cardiovascular outcomes associated with use of clarithromycin: population based study. BMJ, 352 h6926.

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DOI (Digital Object Identifier) Link: https://doi.org/10.1136/bmj.h6926
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Abstract

Study question What is the association between clarithromycin use and cardiovascular outcomes?
Methods In this population based study the authors compared cardiovascular outcomes in adults aged 18 or more receiving oral clarithromycin or amoxicillin during 2005-09 in Hong Kong. Based on age within five years, sex, and calendar year at use, each clarithromycin user was matched to one or two amoxicillin users. The cohort analysis included patients who received clarithromycin (n=108 988) or amoxicillin (n=217 793). The self controlled case series and case crossover analysis included those who received Helicobacter pylori eradication treatment containing clarithromycin. The primary outcome was myocardial infarction. Secondary outcomes were all cause, cardiac, or non-cardiac mortality, arrhythmia, and stroke.
Study answer and limitations The propensity score adjusted rate ratio of myocardial infarction 14 days after the start of antibiotic treatment was 3.66 (95% confidence interval 2.82 to 4.76) comparing clarithromycin use (132 events, rate 44.4 per 1000 person years) with amoxicillin use (149 events, 19.2 per 1000 person years), but no long term increased risk was observed. Similarly, rate ratios of secondary outcomes increased significantly only with current use of clarithromycin versus amoxicillin, except for stroke. In the self controlled case analysis, there was an association between current use of H pylori eradication treatment containing clarithromycin and cardiovascular events. The risk returned to baseline after treatment had ended. The case crossover analysis also showed an increased risk of cardiovascular events during current use of H pylori eradication treatment containing clarithromycin. The adjusted absolute risk difference for current use of clarithromycin versus amoxicillin was 1.90 excess myocardial infarction events (95% confidence interval 1.30 to 2.68) per 1000 patients.
What this study adds Current use of clarithromycin was associated with an increased risk of myocardial infarction, arrhythmia, and cardiac mortality short term but no association with long term cardiovascular risks among the Hong Kong population.

Item Type: Journal Item
Copyright Holders: 2016 BMJ Publishing Group Ltd.
ISSN: 1756-1833
Academic Unit/School: Faculty of Science, Technology, Engineering and Mathematics (STEM) > Mathematics and Statistics
Faculty of Science, Technology, Engineering and Mathematics (STEM)
Item ID: 48028
Depositing User: Yonas Ghebremichael Weldeselassie
Date Deposited: 19 Dec 2016 15:33
Last Modified: 03 May 2019 09:16
URI: http://oro.open.ac.uk/id/eprint/48028
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