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The Risk of Community-Acquired Pneumonia in Children Using Gastric Acid Suppressants

EUROPEAN RESPIRATORY JOURNAL(2021)

Maastricht Univ Med Ctr MUMC | Univ Utrecht

Cited 9|Views52
Abstract
Background With the increased use of acid suppressants, significant potential complications such as community-acquired pneumonia (CAP) are becoming more apparent. Paradoxically, in spite of an increased focus on potential complications, there is an increased use of acid suppressants in children and a lack of data specifically targeting the association between acid suppressants and CAP. Our main objective was to evaluate the risk of CAP in children using acid suppressants (proton pump inhibitors (PPIs) and/or histamine-2 receptor antagonists (H2RAs)). Methods We performed a cohort study using data from the UK Clinical Practice Research Datalink. All patients aged 1 month to 18 years with a prescription of acid suppressants were included and matched to up to four unexposed children. Time-varying Cox proportional hazards models were used to estimate the risk of CAP. The cohort consisted of 84868 exposed and 325329 unexposed children. Results Current use of PPIs and H2RAs was associated with an increased risk of CAP (adjusted hazard ratio 2.05 (95% CI 1.90-2.22) and 1.80 (95% CI 1.67-1.94), respectively). The risk was even greater in patients with respiratory disease. Long-term use (>= 211 days) of PPIs and H2RAs led to a significantly greater risk of CAP compared with short-term use (<31 days). After cessation of therapy, the risk remained increased for the following 7 months. Conclusion The use of acid suppressants in children was associated with a doubled risk of CAP. This risk increased with chronic use and respiratory disease, and remained increased after discontinuation of therapy.
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要点】:本文研究了儿童使用胃酸抑制剂(包括质子泵抑制剂和组胺-2受体拮抗剂)与社区获得性肺炎(CAP)风险之间的关系,发现使用这些抑制剂与CAP风险增加相关,且风险随长期使用和呼吸系统疾病而升高。

方法】:作者采用队列研究方法,利用英国临床实践研究数据库的数据进行分析,将使用胃酸抑制剂的儿童与未使用的儿童进行匹配,使用时间变化的Cox比例风险模型估计CAP的风险。

实验】:研究包含84868名使用胃酸抑制剂的儿童和325329名未使用儿童的数据,结果显示,当前使用质子泵抑制剂和组胺-2受体拮抗剂的儿童CAP风险分别增加了2.05倍和1.80倍,长期使用这些药物与CAP风险显著增加相关,并且在停药后7个月内风险仍然升高。