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Proton‐pump inhibitors and the risk of antibiotic use and hospitalisation for pneumonia
Author(s) -
Roughead Elizabeth E,
Ramsay Emmae N,
Pratt Nicole L,
Ryan Philip,
Gilbert Andrew L
Publication year - 2009
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2009.tb02307.x
Subject(s) - medicine , pneumonia , veterans affairs , relative risk , antibiotics , clinical endpoint , confounding , risk factor , cohort study , population , intensive care medicine , confidence interval , randomized controlled trial , environmental health , microbiology and biotechnology , biology
Objective: To determine whether proton‐pump inhibitor (PPI) use is associated with hospitalisations for pneumonia and with antibiotic use. Design and setting: Historical cohort study in the Australian veteran population, conducted from 1 January 2002 to 30 December 2006, comparing veterans exposed to PPIs with those not exposed. Participants: All 185 533 veterans who were Gold Card holders (ie, eligible for all health services subsidised by the Department of Veterans’ Affairs) and aged 65 years and over at 1 January 2002 and had been prescribed at least one medicine in the previous 6 months. Main outcome measures: The primary endpoint was hospitalisation for pneumonia. Secondary endpoints included hospitalisation for bacterial pneumonia and dispensings of antibiotics commonly used to treat respiratory tract infections. Results: After adjustment for potential confounders, we found an increased risk of hospitalisation for pneumonia among those exposed to PPIs compared with the unexposed group (rate ratio [RR], 1.16; 95% CI, 1.11–1.22). The risk was not increased for bacterial pneumonia (RR, 1.13; 95% CI, 0.98–1.31), which made up 8% of pneumonia cases. An increased risk of antibiotic dispensings was observed among those exposed to PPIs (RR, 1.23; 95% CI, 1.21–1.24). Conclusions: PPI dispensings were found to be associated with a small but significant increased risk of hospitalisation for pneumonia. While the increased risk is small, the prevalent use of PPIs means that many people could be affected.