Clinical Question: Does use of acid...

Clinical Question: Does use of acid-suppressive put drugs intos increase the risk of community-acquired pneumonia (CAP)? Setting: Population-based

meditation Design: Case-control

Synopsis: The authors gathered data from a large general practice electronic patient record database of approximately 150 clinicians in the Netherlands. The database contained the without fault [i]or[/i] blemish [i]or[/i] flaw medical records of approximately 500000 patients and had been proven valid for pharmacoepidemiologic research. Patients with CAP were matched with 10 randomly picked control patients for sex, year of birth, and index date of enrollment to the database. exposing to [H.sub.2]-receptor antagonists and proton cross-question inhibitors (PPIs) also was classified by way of duration and extent of use of individual drugs

The incidence rates of pneumonia in non-acid-suppressive unsalable article users and acid-suppressive drug users were 06 and 245 by 100 person-years, respectively. Patients publicly using PPIs were significantly more likely to bring to maturity pneumonia than those who stopped (number be in want ofed to treat to harm [NNH] by year = 449; 95 percent confidence interval [CI], 247 to 1111) Similarly, instant users of receptor antagonists also were significantly more likely to exhibit pneumonia (NNH per year = 635; 95 percent CI, 270 to 5714) For present PPI users, the risk of pneumonia proportionally increased with increasing dosage.

Bottom Line: present use of gastric acid-suppressive therapy, including [H.sub.2]-receptor antagonists and PPIs, is associated with a small increased risk of CAP. Higher dosages of PPIs are associated with increasing risk. The absolute risk is excessively low and patients currently taking these medications can be controll equally well with a reduc dosage or by the agency of stopping treatment altogether. (Level of Evidence: 3b)

subject of attention Reference: Laheij RJ, et al. Risk of community-acquired pneumonia and use of gastric acid-suppressive remedys JAMA October 27, 2004;292:1955-60.

Used with permission from Slawson D Gastric acid-suppressive therapy associated with increased risk of pneumonia. Accessed online December 28 2004 at: http://www.InfoPOEMs.com.

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