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(Stroke. 2003;34:e163.)
© 2003 American Heart Association, Inc.

Research Reports

Antibiotics in Primary Prevention of Stroke in the Elderly

Paul Brassard, MD, MSc; Chantal Bourgault, PhD; James Brophy, MD, PhD; Abbas Kezouh, PhD Samy Suissa, PhD

From the Departments of Medicine and Epidemiology and Biostatistics, McGill University (P.B., J.B., S.S.), and Division of Clinical Epidemiology, Royal Victoria Hospital (P.B., C.B., J.B., A.K., S.S.), and Division of Cardiology (J.B.), McGill University Health Center, Montreal, Canada.

Reprint requests to Paul Brassard, MSc, MD, Division of Clinical Epidemiology, Royal Victoria Hospital (MUHC), 687 Pine Ave W, Ross 4.29, Montreal, Quebec, Canada H3A 1A1. E-mail paul.brassard{at}clinepi.mcgill.ca

Background and Purpose— An increasing number of reports have linked infections to atherosclerosis and thrombosis. Thus, use of antibiotics may lower the risk of developing cerebrovascular disease. We investigated whether antibiotic use is associated with the risk of stroke in elderly individuals treated for hypertension.

Methods— A cohort of 29 937 elderly subjects initiating antihypertensive therapy between 1982 and 1995 was formed from the Quebec healthcare insurance database. A nested case-control design was used in which each subject hospitalized with a primary discharge diagnosis of stroke between 1987 and 1995 was matched on calendar time to 5 randomly selected controls from the cohort. Conditional logistic regression was used to estimate odds ratios of stroke after adjustment for predisposing factors.

Results— We identified 1888 cases and 9440 controls. The overall adjusted odds ratio for current antibiotic use was 0.80 (95% confidence interval, 0.63 to 1.01), and that for recent use was 0.81 (95% confidence interval, 0.70 to 0.94). Penicillin was the only individual antibiotic class that showed a protective association across different time windows. No significant association was found between stroke risk and the use of fluoroquinolones, macrolides, tetracyclines, or cephalosporins.

Conclusions— Although no clear, consistent associations between overall antibiotic use and cerebrovascular disease could be found, an intriguing association between penicillin use and stroke should be explored further.

Key Words: antibiotics • atherosclerosis • case-control studies • infection • primary prevention • stroke

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