Use of Proton Pump Inhibitors and the Risk of Community-Acquired Pneumonia

Abstract

Background: Recently, the use of proton pump inhibitors (PPIs) has been associated with an increased risk of pneumonia. We aimed to confirm this association and to identify the risk factors. Methods: We conducted a population-based casecontrol study using data from the County of Funen, Denmark. Cases (n = 7642) were defined as all patients with a first-discharge diagnosis of community-acquired pneumonia from a hospital during 2000 through 2004. We also selected 34 176 control subjects, who were frequency matched to the cases by age and sex. Data on the use of PPIs and other drugs, on microbiological samples, on x-ray examination findings, and on comorbid conditions were extracted from local registries. Confounders were controlled by logistic regression. Results: The adjusted odds ratio (OR) associating current use of PPIs with community-acquired pneumonia was 1.5 (95% confidence interval [CI], 1.3-1.7). No association was found with histamine 2-receptor antagonists (OR, 1.10; 95% CI, 0.8-1.3) or with past use of PPIs (OR, 1.2; 95% CI, 0.9-1.6). Recent initiation of treatment with PPIs (0-7 days before index date) showed a particularly strong association with communityacquired pneumonia (OR, 5.0; 95% 2.1-11.7), while the risk decreased with treatment that was started a long time ago (OR, 1.3; 95% CI, 1.2-1.4). Subgroup analyses revealed high ORs for users younger than 40 years (OR, 2.3; 95% CI, 1.3-4.0). No dose-response effect could be demonstrated. Conclusion: The use of PPIs, especially when recently begun, is associated with an increased risk of communityacquired pneumonia.

Proton pump inhibitor-associated pneumonia: Not a breath of fresh air after all?

“…In a case-control study conducted by Gulmez [47] , 7642 patients with their first diagnosis of community-acquired pneumonia (CAP) were compared with 34 176 healthy controls matched by age and gender from 2000 to 2004. PPI exposure was assessed by determining if the patients had redeemed a prescription for a PPI during the past 90 d. If a prescription had not been redeemed in the past 90 d, the patients were considered to be past users of PPIs and patients who had redeemed a PPI prescription within 90 d were assumed to be current users.…”

“…The Gulmez study [47] suggested that young, healthy patients who have not had a previous hospital admission and have not been administered antibiotics in the past 90 d are actually at an increased risk of contracting community-acquired pneumonia (Table 2). Unfortunately, this study only included patients who have never had a prior diagnosis of pneumonia.…”

Prevalence and appropriateness of drug prescriptions for peptic ulcer and gastro-esophageal reflux disease in a cohort of hospitalized elderly

“…Although generally well tolerated, PPI can cause serious adverse reactions. Their short-term use has been associated with infections such as community-acquired pneumonia [18][19][20][21] or Clostridium difficile diarrhea [22,24] due to low gastric acidity, and with a loss of efficacy of clopidogrel as a result of drug interaction [25][26][27][28][29][30]. Longterm use has been related to increases in hip fractures [31][32][33], delayed diagnosis of gastric cancer and increased risk of all-cause mortality [34,35].…”

Effets indésirables des inhibiteurs de la pompe à proton : faut-il craindre de les prescrire au long cours ?

“…Une étude cas-témoin nichée dans une cohorte issue d'une base de données de médecine générale hollandaise [13] et une étude castémoin danoise [14] ont conclu à une association entre la prise d'IPP et une augmentation de risque de pneumopathie communautaire. Les hypothèses avancées pour expliquer ce risque de pneumonie communautaire chez les patients sous IPP sont [13] :…”