title: Acid suppressive agents and risk of Mycobacterium tuberculosis: case-control study.
abstract: BACKGROUND
  The acid-suppressive agents have been linked with an increased risk of infectious disease. The relationship between these drugs and Mycobacterium Tuberculosis (TB) was not been reported.
  
  
  METHODS
  We conducted a case-control study using data from National Health Insurance research database of Taiwan. From 1996 till 2008, and 6541 cases were defined as TB infection/activation (ICD-9 coding plus prescription two of four first-line anti-TB regimen for at least one month). Control subjects who were matched to the TB cases by age and sex were selected with 10:1 ratio. Medical records including acid-suppressive agent prescription and comorbidity, and socioeconomic status were analyzed.
  
  
  RESULTS
  TB infection/activation was more frequent to comorbidity with chronic diseases, alcohol abuse, malignancy, immune deficient/suppression status and acid-related disease (peptic ulcer, reflux esophagitis). Among the TB cases, there was higher exposure record to acid-suppressive agents within 3 months before TB index date (OR 2.43(2.06-2.88) and 1.90 (1.68-2.14) for proton pump inhibitor (PPI) and histamine 2 receptor antagonist (H2RA) respectively). After adjusting confounding factors, PPIs prescription 3 months before TB index date had an association of TB infection/activation (adjusted OR 1.63(1.61-1.63)). Similar result was found in H2RA user (adjusted OR 1.51(1.50-1.52)). The association of acid-suppressive agents in TB infection/activation was fade gradually when the drug prescription period extended.
  
  
  CONCLUSIONS
  Recent prescription of acid-suppressive agent seems to associate the TB infection/activation. In the society where TB was prevalent, evaluation of pulmonary TB before prescription of PPI or H2RA is warranted.
authors.forename: Wen-Hung
authors.initials: WH
authors.lastname: Hsu
authors.forename: Chao-Hung
authors.initials: CH
authors.lastname: Kuo
authors.forename: Sophie S W
authors.initials: SS
authors.lastname: Wang
authors.forename: Chien-Yu
authors.initials: CY
authors.lastname: Lu
authors.forename: Chung-Jung
authors.initials: CJ
authors.lastname: Liu
authors.forename: Seng-Kee
authors.initials: SK
authors.lastname: Chuah
authors.forename: Fu-Chen
authors.initials: FC
authors.lastname: Kuo
authors.forename: Yen-Hsu
authors.initials: YH
authors.lastname: Chen
authors.forename: Yaw-Bin
authors.initials: YB
authors.lastname: Huang
authors.forename: Ming-Feng
authors.initials: MF
authors.lastname: Hou
authors.forename: Deng-Chyang
authors.initials: DC
authors.lastname: Wu
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City 807, Taiwan. kevinhu837@gmail.com.
authors.forename: Huang-Ming
authors.initials: HM
authors.lastname: Hu
mesh_terms: D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D014376:Tuberculosis / Q000453:epidemiology*
chemical_list: D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors