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December 1, 1999

Antibiotic Use and Risk of Myocardial Infarction

Author Affiliations

Phil B.FontanarosaMD, Interim CoeditorIndividualAuthorMargaret A.WinkerMD, Deputy EditorIndividualAuthorStephenLurieMD PhD, Fishbein FellowIndividualAuthor

JAMA. 1999;282(21):1997-1999. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-21-jbk1201

To the Editor: Dr Meier and colleagues1 interpreted their findings as consistent with an antibiotic effect against vascular infections that may have a causal role in myocardial infarction, but they were careful to emphasize that their data do not support the current use of antibiotics to prevent AMI.

In contrast, some evidence suggests that antibiotics might, under some circumstances, be associated with triggering AMI. A case-control study (980 cases, 3136 controls) of antibiotic use in the 6-month period prior to hospitalization for acute vascular events (mainly myocardial infarction and stroke) using an administrative database including 160,194 enrollees of a Wisconsin health maintenance organization found an overall "protective" effect of antibiotic use (18.7% of cases, 22.1% of controls; P = .02).2 However, antibiotic use in the month prior to hospitalization was "protective" only for adults aged 70 years or older (odds ratio [OR], 0.6; 95% confidence interval [CI], 0.5-0.8), "neutral" for adults aged 60-69 years (OR, 1.1; 95% CI, 0.8-1.5), and a "risk factor" for adults younger than 60 years (OR, 1.6; 95% CI, 1.2-2.0). The authors hypothesized that 1 possible explanation for this age-related risk profile was that antibiotics produced unstable plaque leading to acute vascular events in younger patients with "soft" plaque containing C pneumoniae, as is the case for the Jarisch-Herxheimer reaction following penicillin treatment for syphilis, which can be disastrous if the lesions are located in coronary arteries.3