PPI Use Isn't Associated with Excess Risk for Community-Acquired Pneumonia

December 1, 2016

PPI Use Isn't Associated with Excess Risk for Community-Acquired Pneumonia

  1. Paul S. Mueller, MD, MPH, FACP

Risk for CAP was greater before starting proton-pump inhibitors than after.

  1. Paul S. Mueller, MD, MPH, FACP

Some observational studies have suggested an association between proton-pump inhibitor (PPI) use and community-acquired pneumonia (CAP). In this analysis drawn from a U.K. population-based database, researchers conducted both a cohort study (comparing risk for CAP in people exposed and people unexposed to PPIs) and a self-controlled case series (comparing risk for CAP within individuals, during times of PPI exposure vs. times of no PPI exposure). The self-controlled study design minimizes unmeasured confounding that might affect cohort study results if less-healthy patients are more likely both to take PPIs and to develop CAP.

In the cohort study (which included 160,000 adults and was adjusted for various comorbidities), adjusted risk for CAP was 67% higher in PPI-exposed participants than in unexposed age- and sex-matched controls. However, in the self-controlled analysis (which included 48,000 adults who had CAP and some duration of PPI exposure), risk for CAP was substantially higher during the 30 days before PPI prescription than during the 30 days after PPI prescription.

Comment

The discordance between results of the cohort study and the self-controlled study suggests that confounding by unmeasured comorbidities explains the association between PPIs and CAP noted in prior observational research. These results should be reassuring to patients who use PPIs for valid reasons, but they don't justify casual indefinite use of PPIs; these drugs have other side effects, are expensive, and probably are overused.

Editor Disclosures at Time of Publication

  • Disclosures for Paul S. Mueller, MD, MPH, FACP at time of publication Consultant / advisory board Boston Scientific (Patient Safety Advisory Board) Editorial boards Medical Knowledge Self-Assessment Program (MKSAP 17 General Internal Medicine Committee); MKSAP 17 General Internal Medicine (author/contributor) Leadership positions in professional societies American Osler Society (Vice President)

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