PT  - JOURNAL ARTICLE
AU  - Frederik Boetius Hertz
AU  - Aksel Jensen
AU  - Jenny D Knudsen
AU  - Magnus Arpi
AU  - Charlotte Andersson
AU  - Gunnar H Gislason
AU  - Lars Køber
AU  - Christian Torp–Pedersen
AU  - Freddy Lippert
AU  - Peter E Weeke
TI  - Does macrolide use confer risk of out-of-hospital cardiac arrest compared with penicillin V? A Danish national case-crossover and case–time–control study
AID  - 10.1136/bmjopen-2017-019997
DP  - 2018 Feb 01
TA  - BMJ Open
PG  - e019997
VI  - 8
IP  - 2
4099  - http://bmjopen.bmj.com/content/8/2/e019997.short
4100  - http://bmjopen.bmj.com/content/8/2/e019997.full
SO  - BMJ Open2018 Feb 01; 8
AB  - Introduction and objectives Macrolides have been associated with proarrhythmic properties, but the evidence is conflicting. We evaluated the risk of out-of-hospital cardiac arrest (OHCA) associated with specific macrolides in a retrospective study. Associations between specific macrolides and OHCA were examined by conditional logistic regression analyses in case-crossover and case–time–control models, using penicillin-V treatment as the comparative reference. From nationwide registries, we identified all OHCAs in Denmark from 2001 to 2010 and use of antibiotics.Ethics The present study was approved by the Danish Data Protection Agency (Danish Data Protection Agency (ref.no. 2007-58-0015, local ref.no. GEH-2014-017, (I-Suite.nr. 02 735)).Participants We identified 29 111 patients with an OHCA. Of these, 514 were in macrolide treatment ≤7 days before OHCA and 1237 in penicillin-V treatment.Results In the case-crossover analyses, overall macrolide use was not associated with OHCA with penicillin V as negative comparative reference (OR=0.90; 95% CI 0.73 to 1.10). Compared with penicillin-V treatment, specific macrolides were not associated with increased risk of OHCA: roxithromycin (OR=0.97; 95% CI 0.74 to 1.26), erythromycin (OR=0.68; 95% CI 0.44 to 1.06), clarithromycin (OR=0.95; 95% CI 0.61 to 1.48) and azithromycin (OR=0.85; 95% CI 0.57 to 1.27).Similar results were obtained using case–time–control models: overall macrolide use (OR=0.81; 95% CI 0.62 to 1.06) and specific macrolides (roxithromycin (OR=0.70; 95% CI 0.49 to 1.00), erythromycin (OR=0.67; 95% CI 0.38 to 1.18), clarithromycin (OR=0.75; 95% CI 0.41 to 1.39) or azithromycin (OR=1.17; 95% CI 0.70 to 1.95)).Conclusion The risk of OHCA during treatment with macrolides was similar to that of penicillin V, suggesting no additional risk of OHCA associated with macrolides.