title: Association of macrolides with overall mortality and cardiac death among patients with various infections: A meta-analysis.
abstract: BACKGROUND
  A large body of evidences suggested that macrolide therapy could improve the survival of patients with various infections. While in the same time, macrolides are known to increase fatal arrhythmogenic risks and cause cardiac death. To assess the risks and benefits of macrolide therapy, we systematically reviewed all studies of macrolide use, cardiac death and mortality among patients with various infections.
  
  
  METHODS
  We searched Pubmed, Embase and Cochrane library and reviewed reference lists from 1980 through April 2015. Studies were included if they compared macrolides to other antibiotics in adults with various infections. The outcome measures were the overall mortality and the risk of cardiac death.
  
  
  RESULTS
  Overall, macrolide use was associated with a statistically significant mortality reduction compared with nonmacrolide use (OR: 0.65, 95% CI: 0.46-0.92). There was no difference in the risk of cardiac death between macrolide and nonmacrolide regimes (OR: 1.43, 95% CI: 0.86-2.40). In subgroup analyses, macrolide use was found to be associated with the decreased risk of mortality in a population of older individuals (age>48 years, OR: 0.69; 95% CI: 0.66-0.72). While in a general population of young and middle-aged adults, the use of macrolide-based regimens could not decrease the risk of death from any cause (age<48 years, OR: 0.42; 95% CI: 0.02-11.01). As for cardiac death, macrolide use was found to be associated with increased risk of cardiac death in a population of older individuals (age>48 years, OR: 1.99; 95% CI: 1.53-2.59).
  
  
  CONCLUSIONS
  Despite the potential cardiotoxic effects, there is a net benefit associated with macrolide use in older patients with various infections and macrolide use except roxithromycin was found to be associated with increased risk of cardiac death in a population of adults aged > 48 years.
authors.affiliation: Department of Pharmacy, First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048, China. Electronic address: lxbj@hotmail.com.
authors.forename: Xiang
authors.initials: X
authors.lastname: Li
authors.affiliation: Medical Department, No. 263 Clinical Department, Beijing Military General Hospital, Beijing 101149, China.
authors.forename: Min
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Pharmacy, First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048, China.
authors.forename: Guiyang
authors.initials: G
authors.lastname: Liu
authors.affiliation: Department of Pharmacy, First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048, China.
authors.forename: Jianli
authors.initials: J
authors.lastname: Ma
authors.affiliation: Department of Pharmacy, First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048, China.
authors.forename: Chuntong
authors.initials: C
authors.lastname: Li
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D001424:Bacterial Infections / Q000188:drug therapy*; D016022:Case-Control Studies; D003643:Death; D006801:Humans; D018942:Macrolides / Q000627:therapeutic use*; D009026:Mortality; D065840:Protective Factors; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides
keywords: Cardiac death; Infection; Macrolides; Meta-analysis; Mortality