Abstract
As described in earlier chapters, mounting evidence suggests that Chlamydia pneumoniae may have a role in the development and/or progression of atherosclerosis and coronary heart disease (CHD). The data suggesting that C. pneumoniae are a potential causative agent in this setting far exceeds that for other proposed infectious agents, and is based on the findings of seroepidemiological studies, direct examination of atheromatous plaque specimens, in vitro experiments and animal models. A further important line of evidence has been the results of preliminary anti-chlamydial antibiotic intervention studies in CHD. This chapter focuses on the potential role of such antimicrobial therapy in the secondary prevention of CHD. The findings of preliminary pilot studies are reviewed, as are the aims and controversies surrounding subsequent large-scale, prospective intervention trials now in progress.
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References
Gupta S, Leatham EW, Carrington D et al. Elevated Chlamydia pneumoniae antibodies, cardiovascular events and azithromycin in male survivors of myocardial infarction. Circulation 1997; 96: 404–17.
Gurfinkel E, Bozovich G, Daroca A, Beck E, Mautner B. Randomised trial of roxithromycin in non-Q-wave coronary syndromes: ROXIS pilot study. Lancet 1997; 350: 404–17.
Foulds G, Shepard RM, Johnson RB. The pharmacokinetics of azithromycin in human serum and tissue. J Antimicrob Chemother 1990; 25(Suppl A): 73–82.
Baldwin DR, Wise R, Andrews JM, Ashby D, Honeybourne D. Azithromycin concentrations at the sites of pulmonary infection. Eur Resp J 1990; 3: 886–90.
Rizzato G, Montemurro L, Fraioli P et al. Efficacy of a three-day course of azithromycin in moderately severe community-acquired pneumonia. Eur Respir J 1995; 8: 398–402.
Havlir DV, Dubé MP, Sattler FR et al. Prophylaxis against disseminated Mycobacterium avium complex with weekly azithromycin, daily rifabutin, or both. N Engl J Med 1996; 335: 392–8.
Gupta S, Leatham EW, Carrington D et al. The effect of azithromycin in post myocardial infarction patients with elevated Chlamydia pneumoniae antibody titers. J Am Coll Cardiol 1997; 755: 209 [abstract].
Sinisalo J, Mattila K, Nieminen MS et al. The effect of prolonged doxycycline therapy on Chlamydia pneumoniae serological markers, coronary heart disease risk factors and forearm basal nitric oxide production. J Antimicrob Chemother 1998; 41: 85–92.
Roche Y, Gougerot-Pocidalo M-A, Forest N, Pocidalo J-J. Macrolides and immunity: Effects of erythromycin and spiramycin on human mononuclear cell proliferation. J Antimicrob Chemother 1986; 17: 195–203.
Anderson R. Erythromycin and roxithromycin potentiate human neutrophil locomotion in vitro by inhibition of leukoattractant-activated superoxide generation and auto-oxidation. J Infect Dis 1989; 159: 966–73.
Konno S, Adachi M, Asano K, Okomoto K, Takahashi T. Anti-allergic activity of roxithromycin: inhibition of interleukin-5 production from mouse T-lymphocytes. Life Sci 1993; 52: 25–30.
Martin D, Bursill J, Qui MR, Breit SN, Campbell T. Alternative hypothesis for efficacy of macrolides in acute coronary syndromes. Lancet 1998; 351: 1858–9.
Bengston A, Karlsson T, Hjalmarson Å, Herlitz J. Complications prior to revascularisation among patients waiting for coronary artery bypass grafting and percutaneous transluminal coronary angioplasty. Eur Heart J 1996; 17: 1846–51.
Kaski JC, Chester MR, Chen L, Katritsis D. Rapid angiographic progression of coronary artery disease in patients with angina pectoris. Circulation 1995; 92: 2058–65.
Gupta S, Camm AJ. Chlamydia pneumoniae, antimicrobial therapy and coronary heart disease: a critical overview. Coron Artery Dis 1998; 9: 339–43.
Anderson JL, Muhlestein JB. Azithromycin in coronary artery disease: Elimination of myocardial infection with Chlamydia. ACADEMIC study. Presented at 47th Scientific session of the American College of Cardiology meeting, Atlanta, Georgia, USA, 1998.
Gupta S, Kaski JC, Camm AJ. Antibiotics therapy and coronary heart disease: hype versus hope? Br J Cardiol 1998; 5: 65–6.
Wise R, Hart T, Cars D et al. Antimicrobial resistance. BMJ 1998; 317: 609–10.
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© 1999 Kluwer Academic Publishers
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(1999). Clinical antibiotic trials in coronary heart disease. In: Gupta, S., Camm, A.J. (eds) Chronic Infection, Chlamydia And Coronary Heart Disease. Developments in Cardiovascular Medicine, vol 218. Springer, Dordrecht. https://doi.org/10.1007/978-0-585-37598-4_6
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DOI: https://doi.org/10.1007/978-0-585-37598-4_6
Publisher Name: Springer, Dordrecht
Print ISBN: 978-0-7923-5797-1
Online ISBN: 978-0-585-37598-4
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