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WILLIAM L. BAKER, PHARM.D., BCPS, is Cardiovascular Pharmacology Fellow, School of Pharmacy, University of Connecticut, Storrs, and Cardiovascular Pharmacology Fellow, Divisions of Cardiology and Drug Information, Hartford Hospital, Hartford, CT. KIMBERLY A. COUCH, PHARM.D., M.A., is Clinical Pharmacy Specialist in Infectious Diseases, Department of Pharmacy, Christiana Care Health System, Newark, DE.

Address correspondence to Dr. Baker at Hartford Hospital, 80 Seymour Street, CB 309, Hartford, CT 06102 (wbaker01{at}harthosp.org).

Purpose. A meta-analysis of randomized, controlled trials that evaluated the effect of the macrolide antibiotic, azithromycin, on clinical outcomes in patients with coronary artery disease (CAD) was conducted. Methods. A systematic literature search of MEDLINE, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews was conducted using specific search terms. Randomized, controlled trials comparing azithromycin or placebo in secondary CAD patients with adequately reported data on mortality and clinical cardiac endpoints were included. A random-effects model was used. Results. Six studies (n = 13,778) met the inclusion criteria. The trials varied in their design. On meta-analysis, azithromycin resulted in a nonsignificant reduction in mortality versus placebo (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.77–1.09; p = 0.31). Four trials reported the rate of nonfatal myocardial infarction (MI). Azithromycin did not have an effect on the rate of nonfatal MI versus placebo (OR, 0.95; 95% CI, 0.80–1.13; p = 0.57). Five trials reported rates of hospitalization in which no significant difference was seen with azithromycin versus placebo (OR, 0.97; 95% CI, 0.80–1.17; p = 0.76). Six trials were used to evaluate the composite cardiovascular endpoint. Again, no significant benefit was seen with azithromycin versus placebo (OR, 0.93; 95% CI, 0.84–1.03; p = 0.218). Conclusion. Meta-analysis showed that azithromycin does not appear to reduce the frequency of recurrent cardiac events in patients with CAD. Results from ongoing trials may clarify the role of azithromycin in the secondary prevention of coronary events. Index terms: Azithromycin; Coronary disease; Macrolides; Mortality; Outcomes