Eleven double-blind RCTs (n=19,217: 9,613 treated and 9,604 placebo) were included in the review.
The authors reported that none of the analyses showed statistical heterogeneity.
All 11 RCTs included in the review were double-blinded and used an intention-to-treat analysis. Nine RCTs reported the use of a blinded end points committee for the adjudication of outcome events. The drop-out rate was 2% or less in all included RCTs, with 6 RCTs having 100% follow-up.
All-cause mortality (11 RCTs, n=19,217).
There was no statistically significant reduction in mortality with antichlamydial antibiotic treatment in comparison with placebo (OR 1.02, 95% CI: 0.89, 1.16, P=0.83). The exclusion of any single study, or restriction of the analysis to studies where participants had positive serology, did not alter the overall result of the analysis.
MI (9 RCTs, n=18,939). There was no statistically significant reduction in the rate of MI with antichlamydial antibiotic treatment in comparison with placebo (OR 0.92, 95% CI: 0.81, 1.04, P=0.19). The exclusion of any single study did not alter the overall result of the analysis.
ACS (10 RCTs, n=17,778).
There was no statistically significant reduction in ACS event rates with antichlamydial antibiotic treatment in comparison with placebo (OR 0.91, 95% CI: 0.76, 1.07, P=0.09). The exclusion of any single study, or restriction of the analysis to studies where participants had positive antichlamydial titres, did not alter the overall result of the analysis.
Funnel plots found no evidence of publication bias.