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Methodology: Observational cohort (1997-2016) using linked data from the Clinical Practice Research Datalink, Hospital Episodes Statistics, and the Office for National Statistics. Patients aged 16-80 years with CRS prescribed a macrolide antibiotic or penicillin were included, comparing prescriptions for macrolide antibiotics to penicillin. Outcomes were all-cause mortality, cardiac death, myocardial infarction, stroke, diagnosis of peripheral vascular disease, and cardiac arrhythmia.
Results: Analysis included 320,798 prescriptions received by 66,331 patients. There were 3,251 deaths, 815 due to cardiovascular causes, 925 incident myocardial infarctions, 859 strokes, 637 diagnoses of peripheral vascular disease, and 1,436 cardiac arrhythmias. A non-statistically significant trend towards increased risk of myocardial infarction during the first 30 days following macrolide prescription was observed (fully adjusted hazard ratio 1.60, 95% confidence interval: 0.95, 2.68, p=0.08). No statistically significant short- or long-term risks were observed for macrolide prescription. No significant risks were identified for clarithromycin in particular.
Conclusions: Although not statistically significant, our best estimates suggest an increased short-term risk of myocardial infarction in patients with CRS following macrolide prescription, supporting previous observational evidence. However, confounding by indication remains a possible explanation for this apparent increased risk. We found no evidence of longer term increased risks.
- cardiovascular events
- 1 Active
- 5 Citations (Scopus)
- 1 Article
Antibiotic usage in chronic rhinosinusitis: analysis of national primary care electronic health recordsHopkins, C., Williamson, E., Morris, S., Clarke, C. S., Thomas, M., Evans, H., Little, P., Lund, V. J., Blackshaw, H., Schilder, A., Philpott, C., Carpenter, J. & Denaxas, S., Dec 2019, In: Rhinology. 57, 6, p. 420-429 10 p.
Research output: Contribution to journal › Article › peer-reviewOpen AccessFile7 Citations (Scopus)11 Downloads (Pure)