Abstract
Background
A large body of evidences suggested that macrolide therapy could improve the survival
of patients with various infections. While in the same time, macrolides are known
to increase fatal arrhythmogenic risks and cause cardiac death. To assess the risks
and benefits of macrolide therapy, we systematically reviewed all studies of macrolide
use, cardiac death and mortality among patients with various infections.
Methods
We searched Pubmed, Embase and Cochrane library and reviewed reference lists from
1980 through April 2015. Studies were included if they compared macrolides to other
antibiotics in adults with various infections. The outcome measures were the overall
mortality and the risk of cardiac death.
Results
Overall, macrolide use was associated with a statistically significant mortality reduction
compared with nonmacrolide use (OR: 0.65, 95% CI: 0.46–0.92). There was no difference
in the risk of cardiac death between macrolide and nonmacrolide regimes (OR: 1.43,
95% CI: 0.86–2.40). In subgroup analyses, macrolide use was found to be associated
with the decreased risk of mortality in a population of older individuals (age > 48 years, OR: 0.69; 95% CI: 0.66–0.72). While in a general population of young and middle-aged
adults, the use of macrolide-based regimens could not decrease the risk of death from
any cause (age < 48 years, OR: 0.42; 95% CI: 0.02–11.01). As for cardiac death, macrolide use was found
to be associated with increased risk of cardiac death in a population of older individuals
(age > 48 years, OR: 1.99; 95% CI: 1.53–2.59).
Conclusion
Despite the potential cardiotoxic effects, there is a net benefit associated with
macrolide use in older patients with various infections and macrolide use except roxithromycin
was found to be associated with increased risk of cardiac death in a population of
adults aged > 48 years.
Keywords
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Article info
Publication history
Published online: September 24, 2015
Accepted:
September 10,
2015
Received:
July 20,
2015
Identification
Copyright
© 2015 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.
