{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T02:43:07Z","timestamp":1792723387672,"version":"4.5.0"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Pediatr"],"published-print":{"date-parts":[[2023,10,1]]},"abstract":"Importance<\/jats:title>Proton pump inhibitor (PPI) use may lead to infections through alteration of the microbiota or direct action on the immune system. However, only a few studies were conducted in children, with conflicting results.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess the associations between PPI use and serious infections in children, overall and by infection site and pathogen.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This nationwide cohort study was based on the Mother-Child EPI-MERES Register built from the French Health Data System (SNDS). We included all children born between January 1, 2010, and December 31, 2018, who received a treatment for gastroesophageal reflux disease or other gastric acid\u2013related disorders, namely PPIs, histamine 2 receptor antagonists, or antacids\/alginate. The index date was defined as the first date any of these medications was dispensed. Children were followed up until admission to the hospital for serious infection, loss of follow-up, death, or December 31, 2019.<\/jats:p><\/jats:sec>Exposure<\/jats:title>PPI exposure over time.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Associations between serious infections and PPI use were estimated by adjusted hazard ratios (aHRs) and 95% CIs using Cox models. PPI use was introduced as time-varying. A 30-day lag was applied to minimize reverse causality. Models were adjusted for sociodemographic data, pregnancy characteristics, child comorbidities, and health care utilization.<\/jats:p><\/jats:sec>Results<\/jats:title>The study population comprised 1\u202f262\u202f424 children (median [IQR] follow-up, 3.8 [1.8-6.2] years), including 606\u202f645 who received PPI (323\u202f852 male [53.4%]; median [IQR] age at index date, 88 [44-282] days) and 655\u202f779 who did not receive PPI (342\u202f454 male [52.2%]; median [IQR] age, 82 [44-172] days). PPI exposure was associated with an increased risk of serious infections overall (aHR, 1.34; 95% CI, 1.32-1.36). Increased risks were also observed for infections in the digestive tract (aHR, 1.52; 95% CI, 1.48-1.55); ear, nose, and throat sphere (aHR, 1.47; 95% CI, 1.41-1.52); lower respiratory tract (aHR, 1.22; 95% CI, 1.19-1.25); kidneys or urinary tract (aHR, 1.20; 95% CI, 1.15-1.25); and nervous system (aHR, 1.31; 95% CI, 1.11-1.54) and for both bacterial (aHR, 1.56; 95% CI, 1.50-1.63) and viral infections (aHR, 1.30; 95% CI, 1.28-1.33).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this study, PPI use was associated with increased risks of serious infections in young children. Proton pump inhibitors should not be used without a clear indication in this population.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapediatrics.2023.2900","type":"journal-article","created":{"date-parts":[[2023,8,14]],"date-time":"2023-08-14T15:01:13Z","timestamp":1692025273000},"page":"1028","source":"Crossref","is-referenced-by-count":94,"title":["Proton Pump Inhibitor Use and Risk of Serious Infections in Young Children"],"prefix":"10.1001","volume":"177","author":[{"given":"Marion","family":"Lassalle","sequence":"first","affiliation":[{"name":"EPI-PHARE, Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM], and French National Health Insurance [CNAM]), Saint-Denis, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Zureik","sequence":"additional","affiliation":[{"name":"EPI-PHARE, Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products 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