Antibiotics after Acute Myocardial Infarction

Giving antibiotics to help prevent inflammation in patients with coronary disease is an attractive idea to clinical researchers for a number of reasons. Many studies have focused on whether antibiotics can help change the course of coronary artery syndromes. Results have been mixed, with smaller studies tending to show benefits but larger trials showing no advantages.

One large study, Antibiotic Therapy after an Acute Myocardial Infarction (ANTIBIO), monitored 868 patients for 12 months. Patients who were given roxithromycin (e.g., Generic Rulid®, Aventis) 300 mg/day for six weeks fared no better and no worse than patients given placebo. Of 431 patients in the drug group, 28 died (6.5%); of 437 placebo patients, 26 died (6%).

The ANTIBIO researchers noted that the type of macrolide ( generic roxithromycin or azithromycin drug [Zithromax tablet, Pfizer]), the type coronary artery disease (unstable or stable), the duration of therapy, and whether or not patients had C. pneumo-niae infection did not seem to have a major impact on the effect of antibiotic treatment. Because smaller trials have been more likely to show benefits, the researchers suggest that the effect of antibiotics, when added to standard therapy, might be very small and perhaps limited to certain patient subgroups, such as patients with high antibody titers. They add that their findings challenge the hypothesis that C. pneumoniae plays a major role in the pathogenesis of arteriosclerosis.