Claricor Case Studies

associated with higher risk of cardiovascular events, while shorter courses (6 days or less), did not have a higher risk of cardiovascular events. In addition, clarithromycin use in patients with previous history of cariodvascular disease was associated with significantly higher risk of cardiovascular events. Also, the relative risk of cardiovascular events with clarithromycin use increased with age (>60 years for COPD cohort, and >70 years for CAP cohort).

2.2.B Strengths The study data was collected from routine care from hospital admission throughout 12 UK 12 hospitals, which strengthens its generalisability. Also, this study considered clinically important outcomes. The follow up was well done; missing data accounted for less than 1%
As opposed to the CLARICOR trial, this study looked at the acute effects of clarithromycin on cardiovascular outcomes, used a more aggressive comparator (antibiotic that is used in more severe disease), and also included younger and relatively healthier patients.

2.4.A Results
For a summary of results of this trial see Appendix 3.

Clarithromycin appeared to have a statistically significant protective association as compared to amoxicillin-clavulanate. This result was likely due to confounding by indication, as amoxicillin-clavulanate was more often prescribed for respiratory tract infection, and is typically reserved for more severe disease.

The use of azithromycin and moxifloxacin was associated with a significant increase in the risk of ventricular arrhythmia and cardiovascular death compared to amoxicillin-clavulanate. The use of levofloxacin was associated with an increased risk of cardiovascular death compared with amoxicillin-clavulanate. Neither clarithromycin or ciprofloxacin showed an association with ventricular arrhythmia or cardiovascular death. It is important to state that while the relative