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Argirios Argiriou:
September 23, 2014
Taking Clarithromycin's Potential Dangers to Heart

Paul S. Mueller, MD, MPH, FACP reviewing Svanström H et al. BMJ 2014 Aug 19.

In a Danish study, current clarithromycin use was associated with excess risk for cardiac death.

Use of the macrolide antibiotics erythromycin and azithromycin has been associated with excess risk for cardiac death, possibly through QT-interval prolongation (NEJM JW Gen Med May 22 2012 and NEJM JW Pediatr Adolesc Med Nov 8 2004). Clarithromycin use has been associated with excess risk for adverse cardiac events in patients with lung disease (NEJM JW Gen Med Apr 9 2013). In this Danish national cohort study of adults (age range, 40–74) who received 7-day courses of clarithromycin, roxithromycin (not marketed in the U.S.), or penicillin, investigators determined risk for cardiac-related death associated with these drugs.

A total of 285 cardiac-related deaths occurred during antibiotic use. In analyses adjusted for potentially confounding variables, current clarithromycin use was associated with significantly higher risk for cardiac-related death than was current penicillin use (5.3 vs. 2.5 deaths/1000 person-years). In contrast, current roxithromycin use and past clarithromycin or roxithromycin use were not associated with excess risk for cardiac-related death.
Comment

In this Danish study, current clarithromycin use was associated with an 80% higher relative risk for cardiac-related death than was current penicillin use; however, the absolute risk was small (only 37 excess cardiac deaths per 1 million treatment courses). Nonetheless, millions of patients worldwide receive prescriptions for macrolide antibiotics — including clarithromycin — every year. In light of these and prior results, avoiding prescribing macrolide antibiotics to patients with known heart disease seems prudent.

Citation(s):

    Svanström H et al. Use of clarithromycin and roxithromycin and risk of cardiac death: Cohort study. BMJ 2014 Aug 19; 349:g4930. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)


- See more at: Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

Loumakis:
   Μια σημαντικη  Καναδικη μελέτη δειχνει ότι η χορηγηση των αντιβιοτικων  κοτριμοξαζολης  ή  σιπροφλοξασινης σε ηλικιωμενους που παιρνουν αντιϋπερτασικά της κατηγοριας του αξονα ρενινης -αγγειοτασινης- αλδοστερονης (α-ΜΕΑ  ή  ΑΥΑ) σχετιζεται με αυξηση του κινδυνου αιφνιδιου θανατου. Στη μεν περιπτωση της κοτριμοξαζολης αυτό οφειλεται σε υπερκαλιαιμία και ο κινδυνος αυξανει με την αυξηση του χρονου θεραπειας , ενώ στην περιπτωση της σιπροφλοξασινης οφειλεται σε παραταση του QT διαστηματος και ο κινδυνος είναι αυξημενος από τις πρωτες μερες της θεραπειας.

  Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

Denominator:
Σημερινή ανάρτηση στον ιστότοπο του FDA:

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος (FDA Drug Safety Communication: FDA warns that DPP-4 inhibitors for type 2 diabetes may cause severe joint pain).

Argirios Argiriou:
08/12/2015

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

Argirios Argiriou:
February 2, 2016

Paul S. Mueller, MD, MPH, FACP reviewing Wong AYS et al. BMJ 2016 Jan 13.

Clarithromycin Is Associated with Excess Cardiovascular Risk.
But excess risk disappears after the antibiotic course is completed.

Evidence suggests clarithromycin use is associated with excess cardiovascular (CV) risk, but whether such risk is short-term or long-term is unclear. In this population-based study, investigators in Hong Kong compared CV outcomes among 109,000 adults who received oral clarithromycin with outcomes among 218,000 adults who received oral amoxicillin (which is not associated with CV risk). Patients were matched by age, sex, and calendar year of antibiotic use.

Propensity-adjusted analyses showed that, with current use, risk for myocardial infarction (MI) was 3.7 times higher and risk for arrhythmia was 2.2 times higher among clarithromycin users than among amoxicillin users. All-cause and cardiac-related mortality was roughly doubled among current clarithromycin users versus current amoxicillin users. These excess risks disappeared after 14 days of clarithromycin use (i.e., after completing the antibiotic course). Stroke risk was not elevated in clarithromycin users at any time. Subgroup analyses showed that risk with clarithromycin use was highest among people older than 75 and for those with hypertension-associated disease or diabetes.

COMMENT

In this study, only current clarithromycin use was associated with excess risk for MI, cardiac arrhythmia, and death. Case reports have linked clarithromycin with QT prolongation and arrhythmia — a possible mechanism for the noted excess CV risk. Overall, caution is necessary when considering clarithromycin, especially in patients with, or at high risk for, CV disease.

EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for Paul S. Mueller, MD, MPH, FACP at time of publication
Consultant / advisory boardBoston Scientific (Patient Safety Advisory Board)
Editorial boardsMedical Knowledge Self-Assessment Program (MKSAP 17 General Internal Medicine Committee); MKSAP 17 General Internal Medicine (author/contributor)
Leadership positions in professional societiesAmerican Osler Society (Vice President)

CITATION(S):

Wong AYS et al. Cardiovascular outcomes associated with use of clarithromycin: Population based study. BMJ 2016 Jan 13; 352:h6926. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

- See more at: Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

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