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Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-analysis Eom CS; Jeon CY; Lim JW; Cho EG; Park SM; Lee KSCMAJ 2011[Feb]; 183 (3): 310-9BACKGROUND: 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.|Antacids/*adverse effects[MESH]|Anti-Ulcer Agents/*adverse effects[MESH]|Community-Acquired Infections/chemically induced/epidemiology[MESH]|Cross Infection/chemically induced/epidemiology[MESH]|Dose-Response Relationship, Drug[MESH]|Histamine H2 Antagonists/*adverse effects[MESH]|Humans[MESH]|Pneumonia/*chemically induced/epidemiology[MESH]|Proton Pump Inhibitors/*adverse effects[MESH] |
