Proton Pump Inhibitors and Infant Pneumonia/Other Lower Respiratory Tract Infections: National Nested Case-control Study

Objective: The possible association between the use of proton pump inhibitors (PPIs) and community-acquired pneumonia (CAP) or any lower respiratory tract infection (LRTI) remains uncertain. We conducted a nested case-control study using routinely collected national health and drug dispensing data in New Zealand to examine the risk of CAP or any LRTI resulting in hospitalization or death in infants dispensed a PPI. Study Design: The cohort included 21,991 patients without a history of CAP or any LRTI who were born between 1 January 2005 and 31 December 2012 and were dispensed omeprazole, lansoprazole, or pantoprazole (the PPIs available in New Zealand during the study period) on at least one occasion during the first year of life. Cases had a first diagnosis after cohort entry (first PPI dispensing) of CAP (n = 65) validated by hospital discharge letter or death record, and chest radiography; or LRTI (including CAP) (n = 566) validated by hospital discharge letter or death record, with or without chest radiography. Up to 10 controls, matched by sex and date of birth, were randomly selected for each case. We conducted complete case analyses for the fully adjusted models. Results: In the adjusted analysis based on CAP cases and their controls, the matched odds ratio for current versus past use of PPIs was 0.88 (95% confidence interval 0.36–2.16). For all LRTI cases and their controls, the matched odds ratio was 1.13 (0.87–1.48). Conclusion: In otherwise healthy community-dwelling infants, current use of a PPI does not appear to increase the risk of CAP or other LRTIs. Address correspondence and reprint requests to Mei-Ling Blank, MPH, Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand (e-mail: meiling.blank@otago.ac.nz) Received 7 November, 2017 Accepted 6 March, 2018 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). Contributors' Statement The New Zealand Pharmacovigilance Centre and Medsafe, and a Strategic Research Grant from the Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand. None of the funders had a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The authors report no conflicts of interest. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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