Anti-Chlamydial Antibiotic Therapy for Symptom Improvement in Peripheral Artery Disease

Background— A potentially strong association exists between Chlamydia pneumoniae and atherosclerosis, but the clinical benefits of antibiotic therapy have not been demonstrated. Preliminary studies of antibiotic therapy in peripheral artery disease have shown a decreased need for revascularization and improved walking ability. The objective of this phase-III trial was to assess the effect of a potent anti-Chlamydial agent, rifalazil, on peak walking time in patients with symptomatic peripheral artery disease. Methods and Results— Patients with intermittent claudication secondary to peripheral artery disease who were seropositive for C pneumoniae were randomized to 25 mg rifalazil once weekly for 8 weeks or matching placebo. Two hundred ninety-seven patients were enrolled from 3 countries and were followed up for 1 year. The mean±SD ankle brachial index at baseline was 0.63±0.16. The primary end point, change from baseline in log peak walking time on a graded treadmill, was assessed 180 days after randomiz...