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Antibiotics as a Means of Secondary Prevention of Coronary Artery Disease: A Systematic Review

Author(s): Abiodun O Aboaba, Toluwani Balogun, Ayesha Khan, Devdat, Raana Zafar, Sabah Ali, Shazia Zeba, Madiha Haseeb, Moyosore Olatunde Olajuwon, Cindy Onumajuru, Arun Kumar Govindan, Juan Carlos Batlle, Yishwerer Karadapanddy, Stephen Dada, Mohammed Mubasheer Ali

Background: According to the World Health Organization, 15.5 million individuals have coronary artery disease (CAD) worldwide. CAD is linked to the blockage/narrowing of coronary arteries that typically occurs due to fatty material/plaque buildup leading to an inflammatory process of athero-sclerosis. A viable intervention may be antibiotics in the secondary prevention of CAD. This systematic review aims to assess the role of antibiotics compared to placebo in the secondary prevention of CAD.

Methodology: This systematic review adhered to PRISMA guidelines. We searched PubMed/MED-LINE, Cochrane Central, Web of Science, and CINAHL Plus. The following keywords were used: Coronary artery disease, coronary heart, acute coronary, antibiotic. Adults aged 18 or above with a diagnosis of CAD (myocardial infarction, stable/ unstable angina) treated with antibiotics or no treatment (i.e., control) were included. In total, seven trials were included, and the results were tabulated.

Results: The trials (6 studies, 336 participants) were conducted in Korea, Finland, India, Canada, Serbia, Greece, and Italy. In total, 123 participants had a positive smoking status, 101 patients had diabetes, 204 participants had hypertension, and 154 had hyperlipidemia. The interventions included doxy-cycline (20-100 mg/day), ciprofloxacin (1000 mg/ day), and erythromycin (25 mg/kg). On noting outcomes post-treatment with antibiotics, the majority of trials presented no statistically significant reductions in CAD adverse outcomes, mechanical ventilation requirements, or length of hospital stay. However, in one trial, Sanati and colleagues reported improvement in echocardiographic findings post-antibiotic treatment. In the TIPTOP trial, the deaths/adverse were less in the antibiotic-treated group but with no statistical significance.

Conclusion: We conclude that antibiotics, whether quinolones or macrolides were either non-beneficial or harmful on assessing death and adverse events among patients with CAD. Current evidence does not support the use of antibiotics for CAD secondary prevention. However, we do posit that larger rand-omized controlled trials may help in concluding once and for all the benefits, if any, in this case. Further studies must ascertain the correct initiation timings of antibiotics, the dosage used, and the treatment period with follow-ups post the 24 months as well.

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