In February 2018, the US drug regula- tory agency (FDA) announced that the summaries of product characteristics (SPCs) of medicines containing clarithromycin would now include a warning about a potential increase in long-term mortality for patients with coronary heart disease treated, even for a short period, with this macrolide antibiotic (1). In 2006, we reported the 3-year results of a placebo-controlled trial of a 2-week course of clarithromycin in patients with coronary heart disease.The purpose of the trial was to evaluate the potential long-term protective effect of clarithromycin against myo-cardial infarction. A role had been hypothesised for the bacterium Chlamydophila (previously called Chlamydia)pneumoniaein inflammation of atheromatous plaques and the detachment of emboli that provoke myocardial infarction (2). However, the mortality rate was higher among patients who received clarithromycin, mainly resulting from increased cardiovascular mortality: 5.1 versus 3.5 (2).
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