Drugs that increase the risk of community-acquired pneumonia: a narrative review

ABSTRACT

Introduction: Community-acquired pneumonia (CAP), a major cause of morbidity and mortality, is the leading infectious cause of death in the developed world. Population-based studies and systematic reviews have identified a large number of risk factors for the development of pneumonia in adults. In addition to age, lifestyle habits, and comorbidities, some forms of pharmacotherapy may also increase the risk for CAP.

Areas covered: MEDLINE, CENTRAL, and Web of Science were used in 2017 to search for case-control, cohort studies, as well as randomized controlled trials and meta-analysis that involved outpatient proton pump inhibitors (PPIs), inhaled corticosteroids (ICSs), antipsychotics, oral antidiabetics, and CAP diagnosis in patients aged >18 years.

Expert opinion: Our review confirmed that the use of ICSs, PPIs or antipsychotic drugs was independently associated with an increased risk for CAP. We also identified a positive association between specific oral antidiabetics and the development of pneumonia.

KEYWORDS:

• Community-acquired pneumonia
• risk factors
• antipsychotics
• inhaled corticosteroids
• proton pump inhibitors

Article highlights

• Several studies and randomized controlled trials reveal that some forms of pharmacotherapy, such as inhaled corticosteroids, proton pump inhibitors, and antipsychotic drugs, may increase the risk for CAP.

• Data from RCTs and observational studies show increased rates of pneumonia in COPD patients treated with ICS, especially in those receiving higher doses, although this risk is not associated with higher mortality.

• Proton pump inhibitors increase the risk for CAP, with the risk being highest at the beginning of therapy.

• There is an association between antipsychotic drug use in elderly patients and pneumonia. The risk for pneumonia varies for the different classes of antipsychotics, being higher for atypical antipsychotics.

• There is an obvious need for prospective trials to define the dose-dependent risk for pneumonia associated with each of these types of drugs and whether there are differences between different populations of patients.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.