Increased Cardiac Risk Linked to Clarithromycin

By Larry Husten

Edited by Lorenzo Di Francesco, MD, FACP, FHM

Acute use of the popular macrolide antibiotic clarithromycin has been linked to a small but significant increase in cardiac death, according to a BMJ study.

Using Danish registries, researchers analyzed the effects of the acute use of penicillin V, roxithromycin, and clarithromycin over a 14-year period.

Clarithromycin was associated with a significantly higher rate of sudden cardiac death than the other two antibiotics: 5.3 per 1000 person-years for clarithromycin versus 2.5 per 1000 person-years for penicillin V and roxithromycin. It should be noted, however, that the absolute number of events was quite low: 285 cardiac deaths occurred during use of the study drugs, 18 of which occurred during use of clarithromycin.

The authors conclude: "On the one hand, the absolute risk is small, so this finding should probably have limited, if any, effect on prescribing practice in individual patients (with the possible exception of patients who have strong risk factors for drug induced arrhythmia). On the other hand, clarithromycin is one of the more commonly used antibiotics in many countries ... thus, the total number of excess (potentially avoidable) cardiac deaths may not be negligible."