한빛사 논문
서울대학교병원
Chun-Sick Eom MD MPH, Christie Y. Jeon ScD, Ju-Won Lim MD, Eun-Geol Cho MD, Sang Min Park MD PhD, Kang-Sook Lee MD PhD
From the Department of Family Medicine (Eom, Lim, Cho, Park), Seoul National University Hospital, Seoul, Republic of Korea; Seoul National University College of Medicine (Park), Seoul, Republic of Korea; the Department of Epidemiology (Jeon), Harvard School of Public
Health, Boston, Mass.; and the Department of Preventive Medicine (Lee), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Correspondence to: Dr. Sang Min Park and Dr. Kang-Sook Lee
Abstract
Background 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, I2 90.5%) and histamine2 receptor antagonists (adjusted OR 1.22, 95% CI 1.09–1.36, I2 0.0%). In the randomized controlled trials, use of histamine2 receptor antagonists was associated with an elevated risk of hospital-acquired pneumonia (relative risk 1.22, 95% CI 1.01–1.48, I2 30.6%).
Interpretation Use of a proton pump inhibitor or histamine2 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.
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