title: Antipsychotic drug use associated with urinary tract infections in older women.
abstract: OBJECTIVE
  Antipsychotic drugs are frequently prescribed to elderly patients, but they are associated with serious adverse effects. The objective of the current study was to investigate the association between use of antipsychotics by elderly women and the risk of urinary tract infections (UTIs).
  Dispensing data were obtained from the PHARMO Database Network for the period 1998-2008.
  
  
  METHODS
  Ambulatory Dutch women (≥65 years) with current and past use of antipsychotics.
  
  
  METHODS
  Incidence rates of UTIs, as defined by use of nitrofurantoin, was calculated within and outside the period of exposure to antipsychotic drugs. Cox proportional hazard regression analysis with Andersen-Gill extension for recurrent events was used to calculate crude and adjusted hazard ratios (HRs).
  
  
  RESULTS
  During the study period, 18,541 women with a first prescription of an antipsychotic were identified. Current use of antipsychotics was associated with an increased risk of UTI compared to past use: HR, adjusted for age and history of UTIs, 1.33, 95% CI 1.27-1.39. A strong temporal relationship was found: the risk of being treated for a UTI was higher in the first week after the start of the treatment (adjusted HR 3.03, 95% CI 2.63-3.50) and decreased after 3 months (adjusted HR 1.22, 95% CI 1.17-1.28). Cumulative exposure was not associated with an increased risk of UTIs. There was no difference in effect between conventional and atypical antipsychotics.
  
  
  CONCLUSIONS
  Our results show an increased risk of uncomplicated UTIs during antipsychotic use in older female patients, especially in the first week of treatment.
authors.affiliation: Department of Geriatric Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. Electronic address: A.v.Strien@jbz.nl.
authors.forename: Astrid M
authors.initials: AM
authors.lastname: van Strien
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Souverein
authors.affiliation: Department of Geriatric Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
authors.forename: Carolina Karen J P W
authors.initials: CK
authors.lastname: Keijsers
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands; Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Eibert R
authors.initials: ER
authors.lastname: Heerdink
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands; Hospital Pharmacy ZANOB, 's-Hertogenbosch, The Netherlands.
authors.forename: Hieronymus Jeroen J
authors.initials: HJ
authors.lastname: Derijks
authors.affiliation: Department of Geriatric Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands; Department of General Practice and Elderly Care Medicine VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Rob J
authors.initials: RJ
authors.lastname: van Marum
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016208:Databases, Factual; D003704:Dementia / Q000188:drug therapy*; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D015994:Incidence; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000209:etiology; D016387:Women's Health
chemical_list: D014150:Antipsychotic Agents
keywords: Antipsychotics; Nitrofurantoin; Urinary tract infection