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Editorial comment--Antibiotics and stroke.

It is sobering to consider that despite its prevalence and prominence, the cause of atherosclerosis remains unknown. In this issue of Stroke , Brassard et al have addressed its intriguing association with inflammation. If infection plays a role in the genesis of vascular events such as stroke, might antibiotics reduce their incidence?

Briefly, Brassard et al examined retrospectively a large data set of elderly hypertensive patients beginning therapy and, after adjustment for confounders, found that antibiotic use, particularly penicillin, was negatively associated with stroke. They noted a “protective association.”

Enthusiasm for a conclusion supporting a popular and intriguing hypothesis should be tempered by consideration of exactly what was done and what was found. Two principles are helpful in assessing the strength of this evidence:

First, in science, an answer cannot be more specific than the question it addresses.

Second, …