Does macrolide use confer risk of out-of-hospital cardiac arrest compared with penicillin V? A Danish national case-crossover and case–time–control study
Introduction and objectives Macrolides have been associated with proarrhythmic properties, but the evidence is conflicting. We evaluated the risk of out-of-hospital cardiac arrest (OHCA) associated with specific macrolides in a retrospective study. Associations between specific macrolides and OHCA w...
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BMJ Publishing Group
2018-02-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/8/2/e019997.full |
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| author | Lars Køber Freddy Lippert Charlotte Andersson Peter E Weeke Gunnar H Gislason Frederik Boetius Hertz Aksel Jensen Jenny D Knudsen Magnus Arpi Christian Torp–Pedersen |
| author_facet | Lars Køber Freddy Lippert Charlotte Andersson Peter E Weeke Gunnar H Gislason Frederik Boetius Hertz Aksel Jensen Jenny D Knudsen Magnus Arpi Christian Torp–Pedersen |
| author_sort | Lars Køber |
| collection | DOAJ |
| description | Introduction and objectives Macrolides have been associated with proarrhythmic properties, but the evidence is conflicting. We evaluated the risk of out-of-hospital cardiac arrest (OHCA) associated with specific macrolides in a retrospective study. Associations between specific macrolides and OHCA were examined by conditional logistic regression analyses in case-crossover and case–time–control models, using penicillin-V treatment as the comparative reference. From nationwide registries, we identified all OHCAs in Denmark from 2001 to 2010 and use of antibiotics.Ethics The present study was approved by the Danish Data Protection Agency (Danish Data Protection Agency (ref.no. 2007-58-0015, local ref.no. GEH-2014-017, (I-Suite.nr. 02 735)).Participants We identified 29 111 patients with an OHCA. Of these, 514 were in macrolide treatment ≤7 days before OHCA and 1237 in penicillin-V treatment.Results In the case-crossover analyses, overall macrolide use was not associated with OHCA with penicillin V as negative comparative reference (OR=0.90; 95% CI 0.73 to 1.10). Compared with penicillin-V treatment, specific macrolides were not associated with increased risk of OHCA: roxithromycin (OR=0.97; 95% CI 0.74 to 1.26), erythromycin (OR=0.68; 95% CI 0.44 to 1.06), clarithromycin (OR=0.95; 95% CI 0.61 to 1.48) and azithromycin (OR=0.85; 95% CI 0.57 to 1.27).Similar results were obtained using case–time–control models: overall macrolide use (OR=0.81; 95% CI 0.62 to 1.06) and specific macrolides (roxithromycin (OR=0.70; 95% CI 0.49 to 1.00), erythromycin (OR=0.67; 95% CI 0.38 to 1.18), clarithromycin (OR=0.75; 95% CI 0.41 to 1.39) or azithromycin (OR=1.17; 95% CI 0.70 to 1.95)).Conclusion The risk of OHCA during treatment with macrolides was similar to that of penicillin V, suggesting no additional risk of OHCA associated with macrolides. |
| format | Article |
| id | doaj-art-a69189b93a2f4139b3f6fcf80a73746d |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2018-02-01 |
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| spelling | doaj-art-a69189b93a2f4139b3f6fcf80a73746d2025-02-12T03:40:11ZengBMJ Publishing GroupBMJ Open2044-60552018-02-018210.1136/bmjopen-2017-019997Does macrolide use confer risk of out-of-hospital cardiac arrest compared with penicillin V? A Danish national case-crossover and case–time–control studyLars Køber0Freddy Lippert1Charlotte Andersson2Peter E Weeke3Gunnar H Gislason4Frederik Boetius Hertz5Aksel Jensen6Jenny D Knudsen7Magnus Arpi8Christian Torp–Pedersen9Department of Cardiology, University Hospital Copenhagen - Rigshospitalet, Copenhagen, DenmarkCopenhagen Emergency Medical Services, Copenhagen University, Copenhagen, Denmark5 Department of Cardiology, Copenhagen University Hospital, Gentofte, Copenhagen, DenmarkDepartment of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark5 Department of Cardiology, Copenhagen University Hospital, Gentofte, Copenhagen, DenmarkDepartment of Clinical Microbiology, Herlev Hospital, Herlev, DenmarkBandim Health Project, Bissau, Guinea-Bissau4 Department of Clinical Microbiology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark1 Department of Clinical Microbiology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark9 Department of Health, Science and Technology, Aalborg University, Aalborg, DenmarkIntroduction and objectives Macrolides have been associated with proarrhythmic properties, but the evidence is conflicting. We evaluated the risk of out-of-hospital cardiac arrest (OHCA) associated with specific macrolides in a retrospective study. Associations between specific macrolides and OHCA were examined by conditional logistic regression analyses in case-crossover and case–time–control models, using penicillin-V treatment as the comparative reference. From nationwide registries, we identified all OHCAs in Denmark from 2001 to 2010 and use of antibiotics.Ethics The present study was approved by the Danish Data Protection Agency (Danish Data Protection Agency (ref.no. 2007-58-0015, local ref.no. GEH-2014-017, (I-Suite.nr. 02 735)).Participants We identified 29 111 patients with an OHCA. Of these, 514 were in macrolide treatment ≤7 days before OHCA and 1237 in penicillin-V treatment.Results In the case-crossover analyses, overall macrolide use was not associated with OHCA with penicillin V as negative comparative reference (OR=0.90; 95% CI 0.73 to 1.10). Compared with penicillin-V treatment, specific macrolides were not associated with increased risk of OHCA: roxithromycin (OR=0.97; 95% CI 0.74 to 1.26), erythromycin (OR=0.68; 95% CI 0.44 to 1.06), clarithromycin (OR=0.95; 95% CI 0.61 to 1.48) and azithromycin (OR=0.85; 95% CI 0.57 to 1.27).Similar results were obtained using case–time–control models: overall macrolide use (OR=0.81; 95% CI 0.62 to 1.06) and specific macrolides (roxithromycin (OR=0.70; 95% CI 0.49 to 1.00), erythromycin (OR=0.67; 95% CI 0.38 to 1.18), clarithromycin (OR=0.75; 95% CI 0.41 to 1.39) or azithromycin (OR=1.17; 95% CI 0.70 to 1.95)).Conclusion The risk of OHCA during treatment with macrolides was similar to that of penicillin V, suggesting no additional risk of OHCA associated with macrolides.https://bmjopen.bmj.com/content/8/2/e019997.full |
| spellingShingle | Lars Køber Freddy Lippert Charlotte Andersson Peter E Weeke Gunnar H Gislason Frederik Boetius Hertz Aksel Jensen Jenny D Knudsen Magnus Arpi Christian Torp–Pedersen Does macrolide use confer risk of out-of-hospital cardiac arrest compared with penicillin V? A Danish national case-crossover and case–time–control study BMJ Open |
| title | Does macrolide use confer risk of out-of-hospital cardiac arrest compared with penicillin V? A Danish national case-crossover and case–time–control study |
| title_full | Does macrolide use confer risk of out-of-hospital cardiac arrest compared with penicillin V? A Danish national case-crossover and case–time–control study |
| title_fullStr | Does macrolide use confer risk of out-of-hospital cardiac arrest compared with penicillin V? A Danish national case-crossover and case–time–control study |
| title_full_unstemmed | Does macrolide use confer risk of out-of-hospital cardiac arrest compared with penicillin V? A Danish national case-crossover and case–time–control study |
| title_short | Does macrolide use confer risk of out-of-hospital cardiac arrest compared with penicillin V? A Danish national case-crossover and case–time–control study |
| title_sort | does macrolide use confer risk of out of hospital cardiac arrest compared with penicillin v a danish national case crossover and case time control study |
| url | https://bmjopen.bmj.com/content/8/2/e019997.full |
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