PROTON PUMP INHIBITORS AND PNEUMONIA: THE DEBATE CONTINUES

▸ Sarkar M, Hennessy S, Yang Y-X. Proton pump inhibitor use and the risk for community-acquired pneumonia. Ann Intern Med 2008;149:391–8.

There have now been two large database studies suggesting that proton pump inhibitor (PPI) use is associated with community-acquired pneumonia (CAP). The biological rationale for this observed effect remains unclear. Now Sarkar and colleagues report another database study examining this issue.

The authors used the General Practice Research Database (GPRD) to conduct a nested case–control study, identifying all cases of CAP between 1987 and 2002. For each of the 80 000 cases of CAP, they selected 10 controls matched according to general practice and length of follow-up in the GPRD. Current use of PPI was defined as any script for PPI within 30 days of the diagnosis of CAP. Conditional logistic regression was performed to adjust for potential confounding, including age, gender, co-morbidity, a previous diagnosis of CAP, and numerous medications that could either compromise the respiratory system or cause immunosuppression. The authors reported no association between current PPI use and pneumonia when adjusting for all these factors (adjusted odds ratio …