title: Association of community-acquired pneumonia with antipsychotic drug use in elderly patients: a nested case-control study.
abstract: 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.
authors.affiliation: Erasmus University Medical Center, PO Box 1738, 3000 DR Rotterdam, The Netherlands. g.trifiro@erasmusmc.nl
authors.forename: Gianluca
authors.initials: G
authors.lastname: Trifirò
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gambassi
authors.forename: Elif F
authors.initials: EF
authors.lastname: Sen
authors.forename: Achille P
authors.initials: AP
authors.lastname: Caputi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Bagnardi
authors.forename: Jose
authors.initials: J
authors.lastname: Brea
authors.forename: Miriam C J M
authors.initials: MC
authors.lastname: Sturkenboom
mesh_terms: 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
chemical_list: D014150:Antipsychotic Agents