[Dr.Vad]

Уважаемый Владимир Яковлевич!

Нынешнее положение дел с антибиотиками при коронарных делах изложено неплохо здесь:

Am Heart J. 2004 Feb;147(2):202-9.

Antibiotics for secondary prevention of coronary artery disease: an ACES hypothesis but we need to PROVE IT.

Gelfand EV, Cannon CP.

Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Mass, USA.

с пока таким заключением:

The general association between Chlamydia pneumoniae and CAD is strong. However, where on the spectrum of CAD, from hemodynamically insignificant coronary atherosclerosis to an ACS, this organism exerts its pathologic effects is less clear. Moreover, the sequence of infection and disease itself has not been proven beyond doubt.

Nevertheless, in the setting of several clinical trials with cardiovascular endpoints, more than 12,000 patients with an established diagnosis of CAD have been now treated with antibiotic therapy directed against C. pneumoniae. The results of these trials are notably disparate and a variety of explanations for these variations have been proposed. These include small sample size, exclusion of seronegative yet potentially infected subjects, insufficient length of treatment of primary infection, reinfection, short follow-up, and more. Ongoing clinical trials involving another projected 14,000 subjects address many of these concerns. Notably, the CLARICOR and ACES trials will utilize macrolide therapy in similar large samples of subjects with stable CAD. Treatment length will differ markedly between the trials—14 days in CLARICOR and 12 months in ACES—likely shedding some light on the influence of that factor on cardiovascular outcomes. The large PROVE IT–TIMI 22 trial takes into consideration the unique aspects of the C. pneumoniae life cycle; its subjects are treated with monthly courses of gatifloxacin for 2 years, with the goal of killing microorganisms when they become reactivated. The relatively long follow-up period of 24 months will help answer the question of whether patients with ACS should be routinely treated with a prolonged course of antibiotics.

In summary, data for the role of antibiotics in secondary prevention of CAD is inconclusive. Based on the available data, routine use of antibiotics for treatment of stable CAD, unstable angina, or acute MI should not be recommended. Results from several ongoing large-scale randomized clinical trials may change this recommendation in the near future.

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