Recently, researchers have been going back to study “time-tested” drugs only find inherent risk. For instance, a common heart drug always believed to be inherently safe is now believed to increase cardiac death. Some antibiotics were recently shown to alter immunity and lead to respiratory disease susceptibility later on.
Clarithromycin, a common antibiotic – lauded by WHO and used for wide variety of infections like gastritis, skin, lung, throat and lyme – can now be added to the list.
It belongs to a group of antibiotics known as macrolides. Macrolide antibiotics prolong the duration of electrical activity of the heart muscle (known as the QT interval) and are therefore thought to increase the risk of potentially fatal heart rhythm problems.
Recent concern and other studies led Danish researchers to believe that the cardiac safety profiles of each macrolide need to be studied in greater detail to help guide future clinical decisions.
So the team decided to assess the risk of cardiac death associated with clarithromycin and another macrolide called roxithromycin – they compared it with penicillin V, an antibiotic with no known cardiac risk.
Using national databases, they identified over 5 million treatment courses among Danish adults aged 40-74 years from 1997 to 2011 (160,297 with clarithromycin, 588,988 with roxithromycin and 4,355,309 with penicillin V). Excluded from the list were people with serious disease or those who may be at high risk of death.
A total of 285 cardiac deaths were observed during ongoing use with the study drugs, 18 of which occurred during use of clarithromycin and 32 during use of roxithromycin.
After further adjustment, over all, clarithromycin was associated with a 76% higher risk of cardiac death compared with use of penicillin V. Or, 37 cardiac per 1 million courses. They did not find a risk for death after treatment ended.
Even with the previous numbers, they conclude no increased risk of cardiac death was found with ongoing or past use of roxithromycin. Perhaps that conclusion has to do with their elimination process.
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Our study expands on the available knowledge of the cardiac safety of macrolides, being the first large scale population based observational study to show significantly increased cardiac risk with clarithromycin and the relative cardiac safety of roxithromycin.
clarithromycin is one of the more commonly used antibiotics in many countries and many millions of people are prescribed this drug each year; thus, the total number of excess (potentially avoidable) cardiac deaths may not be negligible.
They stress that the absolute risk is small but conclude that, before these results are used to guide clinical decision making:
…confirmation in independent populations is an urgent priority given the widespread use of macrolide antibiotics.
While the risk of cardiac death may sound small, there are other side effects to clarithromycin like vomiting, diarrhea, insomnia and abnormal liver function. Here are many more side effects.
During acute crises, a person needs to decide their best course of action. In the long run, though, it may be best to also focus on the immune system and have some high-power antibiotic herbals in their arsenal.
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