Are proton pump inhibitors associated with the development of community-acquired pneumonia? A meta-analysis

Abstract Purpose Proton pump inhibitors (PPIs), one of the most widely used medications, are commonly used to suppress several acid-related upper gastrointestinal disorders. Acid-suppressing medication use could be associated with increased risk of community-acquired pneumonia (CAP), although the results of clinical studies have been conflicting. Data sources A comprehensive search of MEDLINE, EMBASE and Cochrane library and Database of Systematic Reviews from the earliest available online year of indexing up to October 2018. Study selection We performed a systematic review and meta-analysis of observational studies to evaluate the risk of PPI use on CAP outcomes. Data extraction Included study location, design, population, the prevalence of CAP, comparison group and other confounders. We calculated pooled odds ratio (OR) using a random-effects meta-analysis. Results of data synthesis Of the 2577 studies screening, 11 papers were included in the systematic review and 7 studies with 65 590 CAP cases were included in the random-effects meta-analysis. In current PPI users, pooled OR for CAP was 1.86 (95% confidence interval (CI), 1.30–2.66), and in the case of recent users, OR for CAP was 1.66 (95% CI, 1.22–2.25). In the subgroup analysis of CAP, significance association is also observed in both high-dose and low-dose PPI therapy. When stratified by duration of exposure, 3–6 months PPIs users group was associated with increased risk of developing CAP (OR, 2.05; 95% CI, 1.22–3.45). There was a statistically significant association between the PPI users and the rate of hospitalization (OR, 2.59; 95% CI, 1.83–3.66). Conclusion We found possible evidence linking PPI use to an increased risk of CAP. More randomized controlled studies are warranted to clarify an understanding of the association between PPI use and risk of CAP because observational studies cannot clarify whether the observed epidemiologic association is a causal effect or a result of unmeasured/residual confounding.

Download Full-text

Proton pump inhibitors and the risk of hospitalisation for community-acquired pneumonia: replicated cohort studies with meta-analysis

Gut ◽

10.1136/gutjnl-2013-304738 ◽

2013 ◽

Vol 63 (4) ◽

pp. 552-558 ◽

Cited By ~ 101

Author(s):

Kristian B Filion ◽

Dan Chateau ◽

Laura E Targownik ◽

Andrea Gershon ◽

Madeleine Durand ◽

...

Keyword(s):

Cohort Studies ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Meta Analysis ◽

Community Acquired Pneumonia

Download Full-text

Proton Pump Inhibitors and the Risk of Community-Acquired Pneumonia: An Updated Meta-analysis

Annals of Pharmacotherapy ◽

10.1177/10600280211039240 ◽

2021 ◽

pp. 106002802110392

Author(s):

Xuejiao Xun ◽

Qifan Yin ◽

Yuhao Fu ◽

Xueru He ◽

Zhanjun Dong

Keyword(s):

Proton Pump Inhibitors ◽

Proton Pump ◽

Literature Search ◽

Primary Outcome ◽

Adverse Reactions ◽

Meta Analysis ◽

Community Acquired Pneumonia ◽

Published Evidence ◽

Increased Risk ◽

Comprehensive Literature Search

Background: Some studies suggested an increased risk of community-acquired pneumonia (CAP) among proton pump inhibitors (PPI) users. However, the published evidence is inadequate to define the association between PPI use and the risk of CAP. Objective: The aims of our meta-analysis were to systematically assess the association between the risk of CAP and PPI use in adults to reduce the adverse effects of PPI and ensure the safety of medication for patients. Methods: A comprehensive literature search was conducted, published between January 1, 2004, and February 1, 2021. The primary outcome was the incidence of CAP. This meta-analysis was performed using odds ratios (ORs) with 95% CIs as effective measures; 13 studies including 2 098 804 patients were enrolled in our meta-analysis. Results: Our study revealed that the incidence of CAP was higher in PPI users than non -PPI users [OR = 1.37 (95% CI = 1.22–1.53)], especially for PPI duration < 30 days [OR = 1.49 (95% CI = 1.34–1.66)]. Compared with non-PPI use, PPI use increased the incidence of CAP in the stroke disease population [OR = 1.52 (95% CI = 1.33–1.75)], but not in the liver disease population [OR = 1.13 (95% CI = 0.98–1.30)]. Conclusions and Relevance: Using PPI could increase the risk of CAP when compared to not using PPI. PPI use increased the incidence of CAP in patients with stroke. Clinicians and clinical pharmacists should weigh the benefits before medication and strictly control the indication of the prescription, so as to reduce adverse reactions.

Download Full-text