Antipsychotic Use and Community-Acquired Pneumonia. Ann Intern Med. 2010;152:I-20. doi: 10.7326/0003-4819-152-7-201004060-00002
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Published: Ann Intern Med. 2010;152(7):I-20.
Antipsychotics are a group of drugs typically used to control symptoms of psychosis. Types of antipsychotics include older, first-generation “typical” agents and newer, second-generation “atypical” agents. Both types are approved by the U.S. Food and Drug Administration for treatment of bipolar disorder, mania, and schizophrenia. Neither type is approved for treatment of behavioral disorders in patients with dementia or for dementia-related psychosis, although doctors sometimes prescribe them for such problems.
Several recent studies suggest that use of antipsychotics in elderly people with dementia is associated with important risks, including increased risk for diabetes, stroke, pneumonia, and death. The studies that specifically examined risk for pneumonia focused mainly on patients hospitalized with that condition.
To learn whether elderly people living in the community who are taking an antipsychotic drug have an increased risk for pneumonia.
Older adults living in the community who received a prescription for an antipsychotic. Many had dementia-related psychosis, behavioral disorders, or anxiety disorders. Few had schizophrenia.
The researchers searched electronic records in a database of Dutch patients followed by general practitioners. They identified adults aged 65 years or older who received a prescription for an antipsychotic between 1996 and 2006. They selected all such patients with diagnoses of pneumonia (case patients). For each case patient, they also selected up to 20 control participants without pneumonia. They then compared the timing of use, type, and dose of the antipsychotic between case patients and control participants.
Compared with past use, current use of antipsychotics was associated with increased risk for pneumonia. Both atypical and typical antipsychotics were associated with increased risk. Higher doses were associated with greater risk than were lower doses. The highest risk for pneumonia was during the first week of treatment.
The researchers did not know whether patients actually took their prescribed medicines. In addition, they did not study elderly people living in nursing homes or long-term care facilities.
Typical and atypical antipsychotics in elderly people seem to be associated with increased risk for community-acquired pneumonia.
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Infectious Disease, Pulmonary/Critical Care, Pneumonia.
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