Randomized trial of post-MI antibiotic therapy yields another negative result. (Infectious Disease Hypothesis in Doubt).

BERLIN -- Six weeks of macrolide antibiotic therapy starting early after acute MI doesn't reduce 1-year mortality or total cardiovascular events, according to a new German study presented at the 24th Congress of the European Society of Cardiology

The Antibiotic Therapy After an Acute Myocardial Infarction (ANTIBIO) trial is the latest in a string of negative clinical trials investigating antimicrobials for prevention of atherosclerotic progression and coronary events.

"ANTIBIO challenges the theory that infection has an important impact on development of atherosclerosis," said ANTIBIO's principal investigator Dr. Ralf Zahn of the Heart Clinic at Ludwigshafen, Germany

Not so fast, countered discussant Dr. Sandeep Gupta of St. Bartholomew's Hospital, London. Perhaps roxithromycin-- the macrolide used in ANTIBIO--was the wrong drug, or 6 weeks of therapy wasn't enough, or significant benefit in selected patients--those with diabetes, perhaps, or smokers--was masked by the treat-all approach, he said.

Two key ongoing trials are expected to report next year. The National Institutes of Health-sponsored Azithromycin and Coronary Events Study (ACES) has randomized 4,000 patients with stable coronary artery disease to 1 year of azithromycin or placebo. And the Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE IT) trial is comparing the two statins as well as antimicrobial therapy vs. ...