2009 Volume 13 Issue 1 Pages 26-30
Background: Some studies have demonstrated that ACE inhibitors, amantadine and cilostazol, prevent aspiration pneumonia. However, it has not been evident whether these drugs also prevent pneumonia among tube-fed patients. The aim of this study was to clarify the effect of these drugs on preventing fever among tube-fed patients.
Subjects: The inpatients of our hospital who were fed by a tube for at least 1 day from October 1, 2005 to September 30, 2007.
Methods: A retrospective cohort study. The parameters were age, drugs, number of days of tube feeding, fever (38℃ or higher) and administration of antibiotics by intravenous drip infusion. The outcomes were the percentage of days of fever and administration of antibiotics to the days of tube feeding.
Analysis: Patients taking ACE inhibitors or/and amantadine were compared with those not taking these agents. In the analysis of antithrombotic agents, we compared the patients taking cilostazol with those taking aspirin (too few patients took ticlopidine or clopidogrel).
Results: The study included 285 patients, mean age was 76.7 years old. Two hundred and twenty-two patients were admitted with cerebrovasculardisease, 28 patients with neuromuscular disease, and 31 patients with other central neurologic diseases or injury. Two hundred and fifty-eight patients were fed through nasogastric tube, 64 patients through gastrostomy tube, and 1 patient jejunostomytube. The proportion of the days of fever and administration of antibiotics was 17.5 days/year and 31.3 days/year, respectively.
(1) ACE inhibitors and amantadine: 26 patients took at least one of these drugs a month, 273 patients took none (some patients began or quit within the study period). The mean age of patients taking and not taking these drugs was 74.9 and 75.9, respectively (p＝0.0237). The proportion of the days of fever was 8.3 vs. 18.3 days/year (p＝0.0002), respectively. The proportion of the days of administration of antibiotics was 18.5 vs. 32.3 days/year (p＜0.0001), respectively.
(2) Antithromboticagents: 30 patients took cilostazol and 30 patients took aspirin. The mean age of patients taking cilostazol and aspirin was 78.1 and 75.4, respectively (p＝0.0022). The proportion of the days of fever was 10.0 vs. 14.4 days/year, respectively (p＜0.0001). The proportion of the days of administration of antibiotics was 20.0 vs. 28.1 days/year, respectively (p＜0.0001).
Conclusions: Our data reveals that the drugs which can improve swallowing reflex may prevent fever among tube-fed patients. We suggest that improving swallowing reflex can be a new strategy for preventing pneumonia associated with tube feeding.
