Acid suppressive agents and risk of Mycobacterium Tuberculosis: case–control study

Abstract

BackgroundThe acid-suppressive agents have been linked with an increased risk of infectious disease. The relationship between these drugs and Mycobacterium Tuberculosis (TB) was not been reported.MethodsWe conducted a case–control study using data from National Health Insurance research database of Taiwan. From 1996 till 2008, and 6541 cases were defined as TB infection/activation (ICD-9 coding plus prescription two of four first-line anti-TB regimen for at least one month). Control subjects who were matched to the TB cases by age and sex were selected with 10:1 ratio. Medical records including acid-suppressive agent prescription and comorbidity, and socioeconomic status were analyzed.ResultsTB infection/activation was more frequent to comorbidity with chronic diseases, alcohol abuse, malignancy, immune deficient/suppression status and acid-related disease (peptic ulcer, reflux esophagitis). Among the TB cases, there was higher exposure record to acid-suppressive agents within 3 months before TB index date (OR 2.43(2.06-2.88) and 1.90 (1.68-2.14) for proton pump inhibitor (PPI) and histamine 2 receptor antagonist (H2RA) respectively). After adjusting confounding factors, PPIs prescription 3 months before TB index date had an association of TB infection/activation (adjusted OR 1.63(1.61-1.63)). Similar result was found in H2RA user (adjusted OR 1.51(1.50-1.52)). The association of acid-suppressive agents in TB infection/activation was fade gradually when the drug prescription period extended.ConclusionsRecent prescription of acid-suppressive agent seems to associate the TB infection/activation. In the society where TB was prevalent, evaluation of pulmonary TB before prescription of PPI or H2RA is warranted.

Lansoprazole use and tuberculosis incidence in the United Kingdom Clinical Practice Research Datalink: A population based cohort

“…Little previous work has been done to investigate the association between PPI use and TB. However, Hsu et al [ 15 ] found an association between acid suppressing medication and an increased risk of TB disease, which on the surface appears at odds with our findings for lansoprazole. However, the association declined to null with increasing duration of therapy with either a PPI or a histamine H2 receptor antagonist.…”

Association between pulmonary tuberculosis and acid suppressive agents

“…The present study indicates that persons with pulmonary tuberculosis were 1.4 times more likely to be exposure to histamine-2 receptor antagonists than those without pulmonary tuberculosis. This finding was compatible with a previous case-control study showing a positive association between tuberculosis and histamine-2 receptor antagonists therapy (OR=1.51; 95% CI 1.50 to 1.52) 5. The case group in our study included subjects with newly diagnosed pulmonary tuberculosis during the period of 2000–2013 (based on International Classification of Diseases 9th Revision-Clinical Modification, ICD-9 codes 010, 011, 012 and 018).…”

Mycobacterial Response to Organic Solvents and Possible Implications on Cross-Resistance With Antimicrobial Agents

“…The proton pump inhibitor omeprazole is effective in several eukaryotic and prokaryotic cells ( da Silva et al, 2011 ) and it also presents antibacterial effects against several bacterial strains including Helicobacter pylori ( Jonkers et al, 1996 ). However, it has been suggested that omeprazole may promote the growth of M. tuberculosis and MAC bacteria due to a high prevalence of infections caused by these bacteria in patients using acid-suppressive agents ( Suzuki et al, 2000 ; Hsu et al, 2014 ).…”