{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T16:44:49Z","timestamp":1790441089930,"version":"4.1.0"},"reference-count":19,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2016,12,21]]},"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether treatment with clarithromycin for respiratory tract infections was associated with an increased risk of cardiovascular (CV) events, arrhythmias or all-cause mortality compared with other antibiotics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort design comparing clarithromycin monotherapy for lower (LRTI) or upper respiratory tract infection (URTI) with other antibiotic monotherapies for the same indication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Routine primary care data from the UK Clinical Practice Research Datalink and inpatient data from the Hospital Episode Statistics (HES).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Patients aged \u226535\u2005years prescribed antibiotic monotherapy for LRTI or URTI 1998\u20132012 and eligible for data linkage to HES.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The main outcome measures were: adjusted risk of first-ever CV event, within 37 days of initiation, in commonly prescribed antibiotics compared with clarithromycin. Secondarily, adjusted 37-day risks of first-ever arrhythmia and all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 700\u2005689 treatments for LRTI and eligible for the CV analysis, there were 2071 CV events (unadjusted event rate: 29.6 per 10\u2005000 treatments). Of 691\u2005998 eligible treatments for URTI, there were 688 CV events (9.9 per 10\u2005000 treatments). In LRTI and URTI, there were no significant differences in CV risk between clarithromycin and all other antibiotics combined: OR=1.00 (95% CI 0.82 to 1.22) and 0.82 (0.54 to 1.25), respectively. Adjusted CV risk in LRTI versus clarithromycin ranged from OR=1.42 (cefalexin; 95% CI 1.08 to 1.86) to 0.92 (doxycycline; 0.64 to 1.32); in URTI, from 1.17 (co-amoxiclav; 0.68 to 2.01) to 0.67 (erythromycin; 0.40 to 1.11). Adjusted mortality risk versus clarithromycin in LRTI ranged from 0.42 to 1.32; in URTI, from 0.75 to 1.43. For arrhythmia, adjusted risks in LRTI ranged from 0.68 to 1.05; in URTI, from 0.70 to 1.22.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CV events were more likely after LRTI than after URTI. When analysed by specific indication, CV risk associated with clarithromycin was no different to other antibiotics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2016-013398","type":"journal-article","created":{"date-parts":[[2017,1,23]],"date-time":"2017-01-23T21:30:56Z","timestamp":1485207056000},"page":"e013398","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":23,"title":["Risk of cardiovascular events, arrhythmia and all-cause mortality associated with clarithromycin versus alternative antibiotics prescribed for respiratory tract infections: a retrospective cohort study"],"prefix":"10.1136","volume":"7","author":[{"given":"Ellen","family":"Berni","sequence":"first","affiliation":[{"name":"Global Epidemiology, Pharmatelligence, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanka","family":"de Voogd","sequence":"additional","affiliation":[{"name":"Mylan, Weesp, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6926-2947","authenticated-orcid":false,"given":"Julian P","family":"Halcox","sequence":"additional","affiliation":[{"name":"Department of Cardiology, College of Medicine, Swansea University, Swansea, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher C","family":"Butler","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian A","family":"Bannister","sequence":"additional","affiliation":[{"name":"Digital Health Labs, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Jenkins-Jones","sequence":"additional","affiliation":[{"name":"Global Epidemiology, Pharmatelligence, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethan","family":"Jones","sequence":"additional","affiliation":[{"name":"Global Epidemiology, Pharmatelligence, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Ouwens","sequence":"additional","affiliation":[{"name":"Mylan, Weesp, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig J","family":"Currie","sequence":"additional","affiliation":[{"name":"Global Epidemiology, Pharmatelligence, Cardiff, UK"},{"name":"The Cochrane Institute of Primary Care & Public Health, Cardiff University, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,1,23]]},"reference":[{"key":"2025121221373927000_7.1.e013398.1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehm516"},{"key":"2025121221373927000_7.1.e013398.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa041747"},{"key":"2025121221373927000_7.1.e013398.3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.18229"},{"key":"2025121221373927000_7.1.e013398.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(96)00377-4"},{"key":"2025121221373927000_7.1.e013398.5","unstructured":"Joint Formulary Committee. 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