Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: We agree with Drs Modest and Kaufmann
that CRP might be helpful in identifying patients most likely to respond to
antibiotic treatment. We are currently exploring the importance of CRP, other
markers of inflammation, and additional measures of C pneumoniae infection as part of our trial.
Dr Nieto cites data to support the role of C pneumoniae in both the initiation of an atherosclerotic plaque and the progression
of such plaques. We agree that a secondary prevention trial cannot define
the value of an intervention in a primary prevention setting. We chose a secondary
prevention trial to study the use of azithromycin mainly for logistical reasons
centered on the incidence of cardiovascular events and the potentially more
favorable risk-benefit assessment were the outcome to be successful.
Dunne MW, Benner RJ, O'Connor CM, Pfeffer MA, Muhlestein JB, Yao L, Gupta S, Fisher MR, Cook TD. Antibiotics and Coronary Heart Disease—Reply. JAMA. 2004;291(3):302. doi:10.1001/jama.291.3.303-a