trimethoprim--sulfamethoxazole-drug-combination and Myocardial-Infarction

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Cardiac Catheterization; Coronary Angiography; Diagnosis, Differential; Electrocardiography; Feeding Behavior; Heart Conduction System; Humans; Hyperkalemia; Lisinopril; Male; Musa; Myocardial Infarction; Potassium; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

There are conflicting reports of an association between Chlamydia pneumoniae (C. pneumoniae) infection and coronary artery disease (CAD); randomized trials of antibiotics for the secondary prevention of CAD are currently underway. Physicians may be tempted to believe that their choice of antibiotic class in treating any infection may alter the risk of CAD. Our objective was to determine if the use of antibiotics with antichlamydial activity in the general population reduces the risk of myocardial infarction. A healthcare claims database with 354,258 patients with continuous health and pharmacy coverage for at least 2 years between January 1, 1991 and December 31, 1997 was used for the analyses. Hazard ratios were derived from proportional hazards models with time-dependent covariates, relating antibiotic prescription to first claim related to incident first myocardial infarction during the observation period, adjusting for previous CAD, age, sex, diabetes, hypertension, hyperlipidemia, and chronic obstructive pulmonary disease. There were a total of 1,684,091 person-years of observation and 16,139 incident myocardial infarctions. The adjusted hazard ratios were 1.10 (95% confidence intervals [CI] 1.04 to 1.16) for macrolides, 1.20 (95% CI 1.13 to 1.26) for quinolones, 1.10 (95% CI 0.96 to 1.21) for cephalosporins, 1.00 (95% CI 0.96 to 1.06) for tetracyclines, 1.01 (95% CI 0.96 to 1.06) for penicillins, and 1.13 (95% CI 0.98 to 1.30) for trimetroprim-sulfamethoxazole. The hazard ratios for individual antibiotics with activity against C. pneumoniae within each group were similar. Use of antibiotics with activity against C. pneumoniae does not reduce the risk of myocardial infarction in the general population.

Topics: Anti-Bacterial Agents; Cephalosporins; Chlamydophila Infections; Chlamydophila pneumoniae; Databases, Factual; Female; Humans; Insurance; Macrolides; Male; Medical Records; Middle Aged; Myocardial Infarction; Penicillins; Pneumonia, Bacterial; Proportional Hazards Models; Quinolones; Retrospective Studies; Risk Factors; Tetracyclines; Trimethoprim, Sulfamethoxazole Drug Combination; United States

A 73 year old male was hospitalised with fever of unknown origin and episodes with septic shock. During the in-hospital stay the clinical situation deteriorated rapidly, and E. coli was isolated from bloodcultures. All routine investigations revealed no specific abnormalities except for the electrocardiogram, which showed an old anterior-apical infarction although no history of cardiac disease was present. A CT-scan of the thorax and a scintigraphy using labelled autologous leucocytes made the diagnosis of a myocardial abscess, located in an apical aneurysm, probable. No other site of infection could be found and so it was decided to perform an aneurysmectomy with abscess evacuation in combination with extensive antibiotic treatment. After two years the patient is doing well. Only one case of survival has been reported before, also after surgical intervention. This underlines the importance of early diagnosis and aggressive therapy especially with regard to the reported high incidence of cardiac rupture.

Topics: Abscess; Aged; Combined Modality Therapy; Drug Combinations; Endocarditis, Bacterial; Escherichia coli Infections; Heart Aneurysm; Humans; Male; Myocardial Infarction; Sulfamethoxazole; Thrombosis; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination