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Recurrent community-acquired pneumonia in patients starting acid-suppressing drugs.
Am J Med. 2010 Jan; 123(1):47-53.AJ

Abstract

BACKGROUND

Several studies suggest that proton pump inhibitors (PPIs) and histamine 2-receptor antagonists (H2s) increase risk of community-acquired pneumonia. To test this hypothesis, we examined a prospective population-based cohort predisposed to pneumonia: elderly patients (> or =65 years) who had survived hospitalization for pneumonia.

METHODS

This study featured a nested case-control design where cases were patients hospitalized for recurrent pneumonia (> or =30 days after initial episode) and controls were age, sex, and incidence-density sampling matched but never had recurrent pneumonia. PPI/H2 exposure was classified as never, past, or current use before recurrent pneumonia. The association between PPI/H2s and pneumonia was assessed using multivariable conditional logistic regression.

RESULTS

During 5.4 years of follow-up, 248 recurrent pneumonia cases were matched with 2476 controls. Overall, 71 of 608 (12%) current PPI/H2 users had recurrent pneumonia, compared with 130 of 1487 (8%) nonusers (adjusted odds ratio [aOR] 1.5; 95% confidence interval [CI], 1.1-2.1). Stratifying the 608 current users according to timing of PPI/H2 initiation revealed incident current-users (initiated PPI/H2 after initial pneumonia hospitalization, n=303) bore the entire increased risk of recurrent community-acquired pneumonia (15% vs 8% among nonusers, aOR 2.1; 95% CI, 1.4-3.0). The 305 prevalent current-users (PPI/H2 exposure before and after initial community-acquired pneumonia hospitalization) were equally likely to develop recurrent pneumonia as nonusers (aOR 0.99; 95% CI, 0.63-1.57).

CONCLUSION

Acid-suppressing drug use substantially increased the likelihood of recurrent pneumonia in high-risk elderly patients. The association was confined to patients initiating PPI/H2s after hospital discharge. Our findings should be considered when deciding to prescribe these drugs in patients with a recent history of pneumonia.

Authors+Show Affiliations

Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alberta, Canada. deurich@ualberta.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20102991

Citation

Eurich, Dean T., et al. "Recurrent Community-acquired Pneumonia in Patients Starting Acid-suppressing Drugs." The American Journal of Medicine, vol. 123, no. 1, 2010, pp. 47-53.
Eurich DT, Sadowski CA, Simpson SH, et al. Recurrent community-acquired pneumonia in patients starting acid-suppressing drugs. Am J Med. 2010;123(1):47-53.
Eurich, D. T., Sadowski, C. A., Simpson, S. H., Marrie, T. J., & Majumdar, S. R. (2010). Recurrent community-acquired pneumonia in patients starting acid-suppressing drugs. The American Journal of Medicine, 123(1), 47-53. https://doi.org/10.1016/j.amjmed.2009.05.032
Eurich DT, et al. Recurrent Community-acquired Pneumonia in Patients Starting Acid-suppressing Drugs. Am J Med. 2010;123(1):47-53. PubMed PMID: 20102991.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recurrent community-acquired pneumonia in patients starting acid-suppressing drugs. AU - Eurich,Dean T, AU - Sadowski,Cheryl A, AU - Simpson,Scot H, AU - Marrie,Thomas J, AU - Majumdar,Sumit R, PY - 2009/03/25/received PY - 2009/05/05/revised PY - 2009/05/15/accepted PY - 2010/1/28/entrez PY - 2010/1/28/pubmed PY - 2010/3/3/medline SP - 47 EP - 53 JF - The American journal of medicine JO - Am J Med VL - 123 IS - 1 N2 - BACKGROUND: Several studies suggest that proton pump inhibitors (PPIs) and histamine 2-receptor antagonists (H2s) increase risk of community-acquired pneumonia. To test this hypothesis, we examined a prospective population-based cohort predisposed to pneumonia: elderly patients (> or =65 years) who had survived hospitalization for pneumonia. METHODS: This study featured a nested case-control design where cases were patients hospitalized for recurrent pneumonia (> or =30 days after initial episode) and controls were age, sex, and incidence-density sampling matched but never had recurrent pneumonia. PPI/H2 exposure was classified as never, past, or current use before recurrent pneumonia. The association between PPI/H2s and pneumonia was assessed using multivariable conditional logistic regression. RESULTS: During 5.4 years of follow-up, 248 recurrent pneumonia cases were matched with 2476 controls. Overall, 71 of 608 (12%) current PPI/H2 users had recurrent pneumonia, compared with 130 of 1487 (8%) nonusers (adjusted odds ratio [aOR] 1.5; 95% confidence interval [CI], 1.1-2.1). Stratifying the 608 current users according to timing of PPI/H2 initiation revealed incident current-users (initiated PPI/H2 after initial pneumonia hospitalization, n=303) bore the entire increased risk of recurrent community-acquired pneumonia (15% vs 8% among nonusers, aOR 2.1; 95% CI, 1.4-3.0). The 305 prevalent current-users (PPI/H2 exposure before and after initial community-acquired pneumonia hospitalization) were equally likely to develop recurrent pneumonia as nonusers (aOR 0.99; 95% CI, 0.63-1.57). CONCLUSION: Acid-suppressing drug use substantially increased the likelihood of recurrent pneumonia in high-risk elderly patients. The association was confined to patients initiating PPI/H2s after hospital discharge. Our findings should be considered when deciding to prescribe these drugs in patients with a recent history of pneumonia. SN - 1555-7162 UR - https://www.unboundmedicine.com/medline/citation/20102991/Recurrent_community_acquired_pneumonia_in_patients_starting_acid_suppressing_drugs_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9343(09)00863-8 DB - PRIME DP - Unbound Medicine ER -