ABSTRACT
OBJECTIVES: Stent implantation produces a systemic increase of inflammatory markers that correlates with Chlamydophila pneumoniae infection in atherosclerotic plaque. We performed a clinical intervention study to investigate the effect of antibiotic treatment on 6-month follow-up angiographic minimal luminal diameter after stenting. METHODS: Ninety patients were randomly assigned to oral azithromycin or placebo in a double-blinded and randomized fashion. Medication was initiated 2 weeks before a pre-scheduled stenting procedure and maintained 12 weeks thereafter. Angiographic outcomes were evaluated by a six-month follow-up angiography and laboratorial parameters were accessed by blood sampling 2 weeks before stenting, within the first 24 h after procedure and additional samples after four weeks and 6 months. RESULTS: Minimal luminal diameter (1.76 +/- 0.56 mm Vs. 1.70 +/- 0.86 mm; P = 0.7), restenosis rate, diameter stenosis, late loss, and binary restenosis rates were comparable in placebo and azithromycin group in the 6 months follow-up. Serum levels of C-reactive protein presented a three fold significant increase in the control group one day after stenting but did not change in the azithromycin group (8.5 [3.0;16.4] Vs. 2.9 [1.7;6.6]-median [25;75 percentile] P < 0.01). CONCLUSIONS: Azithromycin does not improve late angiographic outcomes but attenuates the elevation of C-reactive protein levels after stenting, indicating an anti-inflammatory effect.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Azithromycin/therapeutic use , C-Reactive Protein/drug effects , Stents/adverse effects , Administration, Oral , Aged , C-Reactive Protein/metabolism , Cell Proliferation/drug effects , Chlamydophila Infections/etiology , Chlamydophila Infections/prevention & control , Chlamydophila pneumoniae/isolation & purification , Coronary Angiography , Coronary Restenosis/etiology , Double-Blind Method , Female , Follow-Up Studies , Humans , Male , Middle Aged , Treatment Outcome , Tunica Intima/drug effects , Tunica Intima/metabolismABSTRACT
Os autores descrevem o caso de um paciente com AIDS que durante período de observaçäo de cinco meses apresentou episódios de bacteremia por Salmonella enteritidis typhimurium näo respondendo satisfatoriamente à antibioticoterapia empregada. Durante a internaçäo näo foram detectadas lesöes focais por Salmonella mas a necropsia evidenciou infecçäo em trato intestinal. Comparam os dados referentes a este caso com os obtidos em revisäo de literatura
