Antibiotics not effective in acute coronary syndromes
Are antibiotics effective in the treatment of acute coronary syndromes?
Antibiotic therapy is no more effective than placebo in reducing the morbidity or mortality in patients with acute coronary syndromes. (LOE = 1a-)
Andraws R, Berger JS, Brown DL. Effects of antibiotic therapy on outcomes of patients with coronary artery disease. A meta-analysis of randomized controlled trials. JAMA 2005;293:2641-47.
Study design: Meta-analysis (randomized controlled trials)
Setting: Various (meta-analysis)
Chlamydia pneumoniae infection is associated with the initiation and progression of atherosclerosis. Clinical trials investigating the effect of antibiotic therapy aimed at eradicating infection with Chlamydia on the outcomes of acute coronary syndromes are mixed. The investigators comprehensively searched multiple databases, including MEDLINE, the Cochrane Central Register for Controlled Trials, bibliographies of retrieved articles, and abstracts from major scientific meetings for potential clinical trials. Only English-language randomized placebo-controlled trials were included. From an initial total of 110 reports, only 11 enrolling 19,217 patients met inclusion criteria. The most common treatment was a single antibiotic such as roxithromycin, azithromycin, clarithromycin, or gatifloxacin. Overall, antibiotic therapy had no significant effect compared with placebo on reducing all-cause mortality or on the combined end point of myocardial infarction and unstable angina. The results were minimally heterogeneous, but exclusion of any single trial from the analysis did not alter the overall findings. There was no evidence of significant publication bias.