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Br J Clin Pharmacol. 2017 Jun;83(6):1298-1308. doi: 10.1111/bcp.13205. Epub 2017 Jan 23.

Acid-suppression medications and bacterial gastroenteritis: a population-based cohort study.

Author information

1
Department of Practice and Policy, School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK.
2
James Paget University Hospitals NHS Foundation Trust, Lowestoft Road, Gorleston-on-Sea. Norfolk, NR31 6LA, UK.
3
Medical Microbiology, Ninewells Hospital, Dundee, DD1 9SY, UK.
4
NHS Tayside, Directorate of Public Health, King's Cross, 350 Clepington Road, Dundee, DD3 8EA, UK.
5
Medicines Monitoring Unit, Division of Medical Sciences, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.

Abstract

AIMS:

To investigate whether acid-suppression medicines (ASMs) increase the risk of bacterial gastroenteritis.

METHODS:

A population-based, propensity-score matched cohort study using a record-linkage database in Tayside, UK. The study consisted of 188 323 exposed to ASMs (proton-pump inhibitors and histamine-2 receptor antagonists) and 376 646 controls (a propensity-score matched cohort from the rest of population who were not exposed to ASMs) between 1999 and 2013. The main outcome measure was a positive stool test for Clostridium difficile, Campylobacter, Salmonella, Shigella or Escherichia coli O157. The association between ASMs and risk of bacterial gastroenteritis was assessed by a Cox regression model.

RESULTS:

There were 22 705 positive test results (15 273 C. difficile [toxin positive], 6590 Campylobacter, 852 Salmonella, 129 Shigella and 193 E. coli O157, not mutually exclusive) with a total of 5 729 743 person-years follow up time in Tayside, 1999-2013. The adjusted hazard ratios for culture positive diarrhoea for the proton-pump inhibitors and histamine-2 receptor antagonists exposed vs. unexposed cohort were 2.72 (95% confidence interval [CI] 2.33, 3.17) during follow-up time for samples submitted from the community and 1.28 (95% CI 1.08, 1.52) for samples submitted from hospitals. Compared with the unexposed cohort, patients in the exposed group had increased risks of C. difficile and Campylobacter [adjusted hazard ratios of 1.70 (95% CI 1.28, 2.25), 3.71 (95% CI 3.04, 4.53) for community samples, and 1.42 (95% CI 1.17, 1.71), 4.53 (95% CI 1.75, 11.8) for hospital samples, respectively].

CONCLUSIONS:

The results suggest that community prescribed ASMs were associated with increased rates of C. difficile and Campylobacter positive gastroenteritis in both the community and hospital settings.

KEYWORDS:

acid-suppression medications; bacterial gastroenteritis; cohort study

PMID:
28054368
PMCID:
PMC5427234
DOI:
10.1111/bcp.13205
[Indexed for MEDLINE]
Free PMC Article

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