Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs.
BACKGROUND
Reduction of gastric acid secretion by acid-suppressive therapy allows pathogen colonization from the upper gastrointestinal tract. The bacteria and viruses in the contaminated stomach have been identified as species from the oral cavity.


OBJECTIVE
To examine the association between the use of acid-suppressive drugs and occurrence of community-acquired pneumonia.


METHODS
Incident acid-suppressive drug users with at least 1 year of valid database history were identified from the Integrated Primary Care Information database between January 1, 1995, and December 31, 2002. Incidence rates for pneumonia were calculated for unexposed and exposed individuals. To reduce confounding by indication, a case-control analysis was conducted nested in a cohort of incident users of acid-suppressive drugs. Cases were all individuals with incident pneumonia during or after stopping use of acid-suppressive drugs. Up to 10 controls were matched to each case for practice, year of birth, sex, and index date. Conditional logistic regression was used to compare the risk of community-acquired pneumonia between use of proton pump inhibitors (PPIs) and H2-receptor antagonists.


METHODS
Community-acquired pneumonia defined as certain (proven by radiography or sputum culture) or probable (clinical symptoms consistent with pneumonia).


RESULTS
The study population comprised 364,683 individuals who developed 5551 first occurrences of pneumonia during follow-up. The incidence rates of pneumonia in non-acid-suppressive drug users and acid-suppressive drug users were 0.6 and 2.45 per 100 person-years, respectively. The adjusted relative risk for pneumonia among persons currently using PPIs compared with those who stopped using PPIs was 1.89 (95% confidence interval, 1.36-2.62). Current users of H2-receptor antagonists had a 1.63-fold increased risk of pneumonia (95% confidence interval, 1.07-2.48) compared with those who stopped use. For current PPI users, a significant positive dose-response relationship was observed. For H2-receptor antagonist users, the variation in dose was restricted.


CONCLUSIONS
Current use of gastric acid-suppressive therapy was associated with an increased risk of community-acquired pneumonia.
Laheij
Robert J F
RJ
Department of Gastroenterology, University Medical Center St. Radboud, Nijmegen, The Netherlands. R.Laheij@mdl.umcn.nl
Sturkenboom
Miriam C J M
MC
Hassing
Robert-Jan
RJ
Dieleman
Jeanne
J
Stricker
Bruno H C
BH
Jansen
Jan B M J
JB
D000328:Adult; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D005744:Gastric Acid; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000382:microbiology; D011014:Pneumonia / Q000453:epidemiology*; D054328:Proton Pump Inhibitors; D012306:Risk; D013270:Stomach / Q000382:microbiology
D000897:Anti-Ulcer Agents; D004791:Enzyme Inhibitors; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors