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Type: Journal article
Title: Proton pump inhibitors and risk of Clostridium difficile infection: a multi-country study using sequence symmetry analysis
Author: Roughead, E.
Chan, E.
Choi, N.
Griffiths, J.
Jin, X.
Lee, J.
Kimura, M.
Kimura, T.
Kubota, K.
Lai, E.
Man, K.
Nguyen, T.
Ooba, N.
Park, B.
Sato, T.
Shin, J.
Wang, T.
Wong, I.
Yang, Y.
Pratt, N.
Citation: Expert Opinion on Drug Safety, 2016; 15(12):1589-1595
Publisher: Taylor & Francis
Issue Date: 2016
ISSN: 1474-0338
Statement of
Elizabeth E Roughead, Esther W Chan, Nam-Kyong Choi, Jenna Griffiths, Xue-Mei Jin ... Nicole L Pratt ... et al.
Abstract: Objective: To determine the association between incident proton pump inhibitor (PPI) use and Clostridium difficile infections across multiple countries Method: National data covering the total population in Australia and Korea, the Canadian population over 65 years and a 3 million person random sample data set from Taiwan were assessed, as were data from a worker insurance population and a hospital inpatient/outpatient population in Japan. Sequence symmetry analysis was used to assess the association with oral vancomycin dispensing as the outcome of interest. Results: 54,957 patients were included. Positive associations were observed in Australia; adjusted sequence ratio (ASR) 2.48 (95% CI 1.90, 3.12), Korea ASR 2.15 (95%CI 2.11, 2.19), Canada ASR 1.45 (95% CI 1.16, 1.79), Japan hospital dataset ASR 3.21 (95%CI 2.12, 4.55) and Japan worker insurance dataset ASR 5.40 (95% CI 2.73, 8.75). The pooled result was ASR 2.40 (95%CI 1.88, 3.05) and 3.16 (95%CI 1.95, 5.10) when limited to Japan, Korean and Taiwan. Results did not vary by individual PPI. The temporal analysis showed effects within the first two weeks of PPI initiation. Conclusion: Our study confirms the association between PPI initiation and C. difficile infections across countries in the Asia-Pacific region.
Keywords: Proton pump inhibitors; Clostridium difficile; adverse event; Asia; sequence symmetry analysis
Rights: © 2016 Informa UK Limited, trading as Taylor & Francis Group
RMID: 0030112079
DOI: 10.1080/14740338.2016.1238071
Grant ID:
Appears in Collections:Pharmacology publications

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