Clarithromycin, an antibiotic regularly used to treat lung infections, is linked with an increased risk of heart disease in people with some lung diseases.
By Clint Witchalls
BMJ Group News
What do we know already?
Clarithromycin, which is a type of antibiotic called a macrolide - a group that also includes erythromycin and azithromycin - is often prescribed for lung infections, including pneumonia, and flare-ups of COPD (chronic obstructive pulmonary disease), when these are caused by a bacterial infection.
Clarithromycin is the most commonly prescribed macrolide antibiotic in the UK.
A previous study showed that, in people with heart disease who took either clarithromycin or a dummy pill for two weeks, people who took clarithromycin had a higher chance of dying early, of heart disease or other causes, than people who didn?t take the antibiotic. Overall around an extra two in every 100 people who took clarithromycin died early compared to people who didn?t. This study also found that the chance of dying remained higher for three years among people who took the drug compared to people who didn?t.
No studies have looked at the long-term effect of clarithromycin in people with COPD or pneumonia.
So researchers decided to follow 1,343 people with flare-ups of COPD and 1,631 people with pneumonia to see if people prescribed clarithromycin had a higher chance of having heart problems than people who weren?t prescribed the drug.
What does the new study say?
Twenty-six in every 100 people who took clarithromycin for flare-ups of COPD symptoms had at least one heart problem (including a heart attack or sudden heart problems, angina, heart failure, and heart rhythm problems) over the course of one year. This was compared with 18 in every 100 people who didn?t take the antibiotic.
Among people with pneumonia, around 13 in every 100 people who took clarithromycin had at least one heart problem in the course of a year compared with 7 in 100 people who didn?t take the antibiotic.
The longer people took clarithromycin, the more likely they were to have heart problems. On average, people in this study took clarithromycin for an average of seven days. Taking clarithromycin for three days or less, or taking other types of antibiotic, didn?t affect people?s risk of heart problems.
How reliable is the research?
Heart problems are a common complication of lung infections. It is possible that people with more severe lung infections - and so at greater risk of heart problems - were more likely to be prescribed clarithromycin. The authors adjusted the figures to take this, and other factors like people?s age, into account. This makes the study more reliable. However, there may be other factors that weren?t taken into account that affected people?s risk of heart problems and we don?t know if these may have affected the results.
This type of study, where patients are monitored for a period of time, is known as a prospective study. These are useful for finding links between things (in this case, taking clarithromycin and heart disease), but they can?t prove that one thing causes another. The authors of the report say that more studies need to be done to prove that clarithromycin is linked with heart disease.
What does this mean for me?
If you have COPD or other lung problems and have been prescribed clarithromycin, particularly long courses of seven days or more, and you are worried about the possible risks, you can talk to your doctor about your concerns.
Source: http://www.webmd.boots.com/heart-disease/news/20130322/antibiotic-clarithromycin-heart-risk
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