Non-steroidal anti-inflammatory drugs and the risk of Clostridium difficile-associated disease

被引:18
作者
Suissa, Daniel [3 ]
Delaney, Joseph A. C. [4 ]
Dial, Sandra [5 ]
Brassard, Paul [1 ,2 ]
机构
[1] McGill Univ, Div Clin Epidemiol, Ctr Hlth, Montreal, PQ H3A 1A1, Canada
[2] McGill Univ, Jewish Gen Hosp, Ctr Clin Epidemiol & Community Studies, Lady Davis Inst, Montreal, PQ H3T 1E2, Canada
[3] Univ Montreal, Ctr Hosp, Div Plast Surg, Montreal, PQ, Canada
[4] Univ Florida, Dept Pharmaceut Outcomes & Policy, Coll Pharm, Gainesville, FL USA
[5] McGill Univ, Div Crit Care & Resp & Clin Res, Ctr Hlth, Montreal, PQ H3A 1A1, Canada
基金
加拿大健康研究院;
关键词
Clostridium difficile; diclofenac; NSAID; risk factor; PRACTICE RESEARCH DATABASE; PSEUDOMEMBRANOUS COLITIS; COMMUNITY; DICLOFENAC; DIARRHEA; INFORMATION;
D O I
10.1111/j.1365-2125.2012.04191.x
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
AIM Several case reports have linked diclofenac, a non-steroidal anti-inflammatory drug (NSAID), with Clostridium difficile associated disease (CDAD). We assessed whether NSAID use in general, and diclofenac use in particular, is associated with an increased risk of CDAD. METHODS We used the United Kingdom's General Practice Research Database (GPRD) to conduct a population-based case-control study. All cases of CDAD occurring between 1994 and 2005 were identified and were matched to 10 controls each. Conditional logistic regression was used to estimate the odds ratio of CDAD associated with current NSAID use, adjusting for covariates. RESULTS We identified 1360 CDAD cases and 13 072 controls. We found an increased risk of CDAD associated with diclofenac (adjusted odds ratio (RR) 1.35, 95% confidence interval (CI) 1.10, 1.67). We did not observe an increased risk of CDAD with use of any other NSAID. No dose-response for diclofenac exposure was found. When we analyzed only patients who were not hospitalized in the year before the index date, we found diclofenac to have a similar effect on CDAD risk (adjusted RR 1.43, 95% CI 1.11, 1.84). CONCLUSION Diclofenac use is associated with a modest increase in the risk of CDAD. In patients at risk of CDAD, other NSAIDs could be prescribed.
引用
收藏
页码:370 / 375
页数:6
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