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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EA post hoc analysis of data from \u0026gt;\u20052000 patients from the CAP-START trial found that macrolide antibiotic use in hospitalized patients with community-acquired pneumonia resulted in an increased risk of cardiac events, including arrhythmia and heart failure, compared with patients who received other antibiotic therapies.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Emacrolide\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eantibiotic\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecommunity-acquired pneumonia\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einfectious diseases clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ebacterial infections\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EMacrolide antibiotic treatment of community-acquired pneumonia (CAP) was associated with an increased risk of cardiac events, such as arrhythmia and heart failure, compared with other antibiotic therapies. Douwe F. Postma, MD, University Medical Center Utrecht, Utrecht, The Netherlands, presented data from a post hoc analysis of the CAP-START trial [Postma DF et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2015].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EInternational guidelines recommend macrolide antibiotics as treatment of CAP. However, an increased risk of cardiac events has been associated with macrolide antibiotic use [Schembri S et al. \u003Cem\u003EBMJ\u003C\/em\u003E. 2013; Ray WA et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2012]. The purpose of this post hoc analysis was to determine if cardiac complications were associated with macrolide use in hospitalized patients with CAP.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn the multicenter, crossover CAP-START trial, \u0026gt;\u20052200 hospitalized patients with CAP randomly received \u03b2-lactam monotherapy, \u03b2-lactam plus macrolide therapy, or fluoroquinolone monotherapy. Each treatment was rotated through participating centers every 4 months. This post hoc analysis examined data from medical charts of new or worsening episodes of heart failure, myocardial ischemia, or arrhythmia according to prespecified criteria using a competing-risk approach. The cause-specific hazard ratio was determined using a Cox proportional hazards model, with the adjusted model accounting for 17 confounders.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAmong the \u0026gt;\u20052000 evaluable patients from the CAP-START study, 15% had CAP due to \u003Cem\u003EStreptococcus pneumoniae\u003C\/em\u003E infection, 33% had a history of cardiac disease, 9% had heart failure, and 15% had diabetes mellitus at baseline. In addition, upon hospitalization, the median blood urea nitrogen level was 6.4 mmol\/L. The median age was 69.5 years, and 58% of patients were men. Macrolide treatment was administered to 30.8% for a minimum of 1 day.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EIn patients who receive macrolide therapy, the cumulative incidence of cardiac events was higher than in patients who did not receive macrolides (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/48\/11.1\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Cumulative Incidence of Cardiac Events According to Macrolide Use in Community-Acquired PneumoniaReproduced with permission from DF Postma, MD.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-590223116\u0022 data-figure-caption=\u0022Cumulative Incidence of Cardiac Events According to Macrolide Use in Community-Acquired PneumoniaReproduced with permission from DF Postma, MD.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/48\/11.1\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/48\/11.1\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/48\/11.1\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16609\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003ECumulative Incidence of Cardiac Events According to Macrolide Use in Community-Acquired Pneumonia\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EReproduced with permission from DF Postma, MD.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EMacrolide use was associated with an increased rate (66%) and net risk (81%) of cardiac events in patients with CAP during hospitalization. Furthermore, macrolide use resulted in an increased risk for cardiac events according to cause-specific (adjusted HR, 1.66; 95% CI, 1.18 to 2.34) and subdistribution (adjusted HR, 1.81; 95% CI, 1.29 to 2.55) analyses. Specifically, macrolide use resulted in greater rates of arrhythmia (3.0% vs 2.3%) and heart failure (7.0% vs 3.7%), but not myocardial ischemia (0.3% vs 0.8%). In addition, macrolide use was associated with a greater proportion of patients experiencing in-hospital death (4.2%) compared with patients who did not receive macrolides (2.6%).\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EIn conclusion, Dr Postma indicated that the data from this post hoc analysis of the CAP-START study suggest that macrolide use is associated with an increased risk of cardiac events, as well as in-hospital death, compared with other antibiotic therapies.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/48\/11.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzllxf\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzllxf\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}