889. Outpatient Proton Pump Inhibitor Therapy and Risk of Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis
Session: Poster Abstract Session: Respiratory Infections
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
  • Crowell IDWeek Poster.pdf (247.5 kB)
  • Background: Community-acquired pneumonia (CAP) is a major cause of morbidity, mortality and healthcare spending. Proton pump inhibitors (PPIs) are among the most commonly prescribed medications worldwide and are often prescribed without an appropriate indication. Several studies have suggested that PPI exposure may be associated with increased risk of CAP. We conducted a systematic review and meta-analysis to evaluate the association between outpatient PPI therapy and risk of CAP in adult patients.

    Methods: Systematic searches of MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Scopus and Web of Science were performed on February 13, 2013. Data were extracted from case-control studies, cohort studies and randomized controlled trials reporting outpatient PPI therapy and CAP diagnosis for patients ≥18 years old.

    Results: Our systematic search yielded 8,057 references, of which 15 satisfied inclusion criteria for this review. These included 10 case-control studies, 4 cohort studies and 1 randomized controlled trial with a total of 1,265,000 participants and 136,349 cases of CAP. Ten of these studies showed a statistically significant increase in pneumonia risk with PPI therapy. The pooled relative risk of CAP with PPI exposure was 1.34 (95% CI 1.20-1.49). Subgroup analysis examining the impact of PPI dose revealed relative risk of 1.37 (1.19-1.58) with high-dose exposure (>1 defined daily dose) and 1.20 (1.01-1.44) with low-dose exposure (≤1 defined daily dose). Subgroup analysis examining the impact of PPI duration revealed relative risk of 2.03 (1.32-3.11) with exposure <1 month, 1.36 (1.06-1.73) with exposure 1-6 months, and 1.21 (0.89-1.63) with exposure >6 months.

    Conclusion: Outpatient proton pump inhibitor therapy is associated with an increased risk of community-acquired pneumonia, particularly at high doses and within the first month after initiation of therapy. Providers should consider the increased risk of pneumonia when prescribing proton pump inhibitor therapy.

    Figure 1. Forest plot of study results evaluating the association between outpatient proton pump inhibitor use and risk of community-acquired pneumonia.

    Trevor Crowell, MD1, Jennifer Lam, MPH2, Cesar Ugarte-Gil, MD, MSc2,3, Julie Paik, MD4, M. Bradley Drummond, MD, MHS5 and Allison Lambert, MD5, (1)Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, (2)Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (3)Instituto De Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru, (4)Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, (5)Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD


    T. Crowell, None

    J. Lam, None

    C. Ugarte-Gil, None

    J. Paik, None

    M. B. Drummond, Boehringer Ingelheim: Phone consultant for one call regarding COPD therapies., Consulting fee and Salary

    A. Lambert, None

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