Benefits and harms of antibiotics for secondary prevention o | Figure 1

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Benefits and harms of antibiotics for secondary prevention of coronary heart disease

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Background

Coronary heart disease, also known as cardiovascular disease, is the leading cause of death worldwide with approximately 7.4 million deaths each year. Coronary heart disease is caused by decreased blood supply to the heart. The severity of the disease ranges from chest pain during exercise to heart attack. Antibiotics might help patients with coronary heart disease and reduce their risk of heart attacks, strokes, chest pain, revascularisation procedures, and death. However, a randomised clinical trial and several observational studies suggested that antibiotics increased the risk of cardiovascular events and death.

Review question

The aim of this Cochrane systematic review was to assess the benefits and harms of antibiotics in adult patients with coronary heart disease.

We primarily assessed the benefits and harms at maximum follow‐up and secondly at 24±6 months follow‐up.

Study characteristics

We searched various scientific databases from their inception to December 2019 and found 38 trials where people with coronary heart disease were randomly allocated to antibiotics versus placebo or no intervention. The 38 trials included 26,638 adults with a mean age of 61.6 years. 23 out of the 38 trials reported data on 26,078 participants that could be analysed. The vast majority of the data was contributed by trials assessing the effects of macrolide antibiotics (28 trials; 22,059 participants) and quinolone antibiotics (two trials; 4162 participants), while insufficient data were contributed by trials assessing the effects of tetracycline antibiotics (eight trials; 417 participants). Three trials were at low risk of bias and the remaining trials were at high risk of bias.

Key results and conclusion

Patients receiving antibiotics (macrolide antibiotics or quinolone antibiotics) compared with patients receiving placebo or no intervention seemed at a slightly higher risk of death from all causes, death from a cardiac cause, and having a stroke at maximum follow‐up. Moreover, a slightly higher risk was also observed when assessing death from all causes, death from a cardiac cause, and sudden death from a cardiac cause at 24±6 months follow‐up. None of the trials sufficiently reported the number of participants with serious adverse events. No data were provided on quality of life.

Future trials on the safety of macrolide antibiotics or quinolone antibiotics for the secondary prevention in adult patients with coronary heart disease do not seem ethical.

Read the full Cochrane Review here

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