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Link to original content: http://pubmed.ncbi.nlm.nih.gov/21173070
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Review
. 2011 Feb 22;183(3):310-9.
doi: 10.1503/cmaj.092129. Epub 2010 Dec 20.

Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-analysis

Chun-Sick Eom  1 , Christie Y Jeon, Ju-Won Lim, Eun-Geol Cho, Sang Min Park, Kang-Sook Lee
Affiliations
Review

Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-analysis

Chun-Sick Eom et al. CMAJ. .

Abstract

Background: Observational studies and randomized controlled trials have yielded inconsistent findings about the association between the use of acid-suppressive drugs and the risk of pneumonia. We performed a systematic review and meta-analysis to summarize this association.

Methods: We searched three electronic databases (MEDLINE [PubMed], Embase and the Cochrane Library) from inception to Aug. 28, 2009. Two evaluators independently extracted data. Because of heterogeneity, we used random-effects meta-analysis to obtain pooled estimates of effect.

Results: We identified 31 studies: five case-control studies, three cohort studies and 23 randomized controlled trials. A meta-analysis of the eight observational studies showed that the overall risk of pneumonia was higher among people using proton pump inhibitors (adjusted odds ratio [OR] 1.27, 95% confidence interval [CI] 1.11-1.46, I(2) 90.5%) and histamine(2) receptor antagonists (adjusted OR 1.22, 95% CI 1.09-1.36, I(2) 0.0%). In the randomized controlled trials, use of histamine(2) receptor antagonists was associated with an elevated risk of hospital-acquired pneumonia (relative risk 1.22, 95% CI 1.01-1.48, I(2) 30.6%).

Interpretation: Use of a proton pump inhibitor or histamine(2) receptor antagonist may be associated with an increased risk of both community- and hospital-acquired pneumonia. Given these potential adverse effects, clinicians should use caution in prescribing acid-suppressive drugs for patients at risk.

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Figures

Figure 1:
Figure 1:
Selection of observational (case–control and cohort) studies (A) and randomized controlled trials (B) evaluating the risk of pneumonia in association with use of acid-suppressive drugs. *Includes nested case–control studies. H2RA = histamine2 receptor antagonist, PPI = proton pump inhibitor, RCT = randomized controlled trial.
Figure 2:
Figure 2:
Meta-analyses of observational studies evaluating the risk of pneumonia among patients receiving acid-suppressive drugs, based on random-effects model. Adjusted odds ratios (ORs) greater than 1 indicate increased risk of pneumonia. CI = confidence interval, I2 = heterogeneity, n = number of events, N = number of patients, NR = not reported.
Figure 3:
Figure 3:
Meta-analysis of randomized controlled trials evaluating the risk of hospital-acquired pneumonia among patients using histamine2 receptor antagonists, based on random-effects model. Relative risk (RR) values greater than 1 indicate increased risk of pneumonia. CI = confidence interval, I2 = heterogeneity, n = number of events, N = number of patients.
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References

    1. Community-acquired pneumonia and acid-suppressive drugs: position statement. Can J Gastroenterol 2006;20:119–21, 123–5. - PMC - PubMed
    1. Roughead EE, Ramsay EN, Pratt NL, et al. Proton-pump inhibitors and the risk of antibiotic use and hospitalisation for pneumonia. Med J Aust 2009;190:114–6 - PubMed
    1. Gregor JC. Acid suppression and pneumonia: a clinical indication for rational prescribing. JAMA 2004;292:2012–3 - PubMed
    1. Vanderhoff BT, Tahboub RM. Proton pump inhibitors: an update. Am Fam Physician 2002;66:273–80 - PubMed
    1. Laine L, Ahnen D, McClain C, et al. Review article: potential gastrointestinal effects of long-term acid suppression with proton pump inhibitors. Aliment Pharmacol Ther 2000;14:651–68 - PubMed

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