Association of community-acquired pneumonia with antipsychotic drug use in elderly patients: a nested case-control study.
BACKGROUND
According to safety alerts from the U.S. Food and Drug Administration, pneumonia is one of the most frequently reported causes of death in elderly patients with dementia who are treated with antipsychotic drugs. However, epidemiologic evidence of the association between antipsychotic drug use and pneumonia is limited.


OBJECTIVE
To evaluate whether typical or atypical antipsychotic use is associated with fatal or nonfatal pneumonia in elderly persons.


METHODS
Population-based, nested case-control study.


METHODS
Dutch Integrated Primary Care Information database.


METHODS
Cohort of persons who used an antipsychotic drug, were 65 years or older, and were registered in the IPCI database from 1996 to 2006. Case patients were all persons with incident community-acquired pneumonia. Up to 20 control participants were matched to each case patient on the basis of age, sex, and date of onset.


METHODS
Risk for fatal or nonfatal community-acquired pneumonia with atypical and typical antipsychotic use. Antipsychotic exposure was categorized by type, timing, and daily dose, and the association with pneumonia was assessed by using conditional logistic regression.


RESULTS
258 case patients with incident pneumonia were matched to 1686 control participants. Sixty-five (25%) of the case patients died in 30 days, and their disease was considered fatal. Current use of either atypical (odds ratio [OR], 2.61 [95% CI, 1.48 to 4.61]) or typical (OR, 1.76 [CI, 1.22 to 2.53]) antipsychotic drugs was associated with a dose-dependent increase in the risk for pneumonia compared with past use of antipsychotic drugs. Only atypical antipsychotic drugs were associated with an increase in the risk for fatal pneumonia (OR, 5.97 [CI, 1.49 to 23.98]).


CONCLUSIONS
Antipsychotic exposure was based on prescription files. Residual confounding due to unmeasured covariates or severity of disease was possible.


CONCLUSIONS
The use of either atypical or typical antipsychotic drugs in elderly patients is associated in a dose-dependent manner with risk for community-acquired pneumonia.
Trifirò
Gianluca
G
Erasmus University Medical Center, PO Box 1738, 3000 DR Rotterdam, The Netherlands. g.trifiro@erasmusmc.nl
Gambassi
Giovanni
G
Sen
Elif F
EF
Caputi
Achille P
AP
Bagnardi
Vincenzo
V
Brea
Jose
J
Sturkenboom
Miriam C J M
MC
D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology*; D012307:Risk Factors; D012680:Sensitivity and Specificity
D014150:Antipsychotic Agents