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Clarithromycin “significantly” increases the likelihood of cardiac death, new research suggests, although the absolute risk was just one in 27,000 courses.

Researchers analysed Danish patients aged 40-74 years, who received clarithromycin (n=160,297), roxithromycin (n=588,988) or penicillin V (n=4,355,309) for seven days. Of these, 285 died from cardiac causes.

The incidence of cardiac death among people taking penicillin V was 2.5 per 1,000 person years. Compared to penicillin V, roxithromycin did not significantly increase cardiac death. However, clarithromycin increased the risk by 76 per cent (5.3 per 1,000 person years), with the link stronger in women (adjusted rate ratio [ARR] 2.83) than men (ARR 1.09, which is non-significant).

The authors suggest that except, possibly, for patients with strong risk factors for drug-induced arrhythmia, the findings “should probably have limited, if any, effect on prescribing practice in individual patients”.

Nevertheless, they point out that clarithromycin is commonly used and the number of “potentially avoidable cardiac deaths may not be negligible”.