Tags

Type your tag names separated by a space and hit enter

Proton pump inhibitors: bacterial pneumonia.

Abstract

After two decades of widespread use, proton pump inhibitors are considered to have a very well-documented and acceptable adverse effect profile in the short-term. Yet adverse effects continue to emerge. In particular, epidemiological studies conducted over the past 10-12 years showed an increased incidence of fractures. New data now point to an increased risk of bacterial pneumonia. A Korean meta-analysis published in 2011 showed a statistically significant increase in the risk of bacterial pneumonia in patients taking proton pump inhibitors, with an odds ratio of 1.27 (95% confidence interval (95% CI): 1.11 to 1.46). The increase in community-acquired pneumonia was also statistically significant, with an odds ratio of 1.34 (95% CI: 1.14 to 1.57). This is consistent with the results of a meta-analysis published in 2010, which gave an odds ratio of 1.36 (95% CI: 1.12 to 1.65). The increase in the frequency of bacterial pneumonia was highest during the first week of treatment, with an odds ratio of 3.95 (95% CI: 2.86 to 5.45). Subsequent studies have provided conflicting results. Possible mechanisms include bacterial passage into the lungs after colonisation of the upper gastrointestinal tract resulting from the reduction in gastric acidity; bacterial overgrowth in the lungs due to a change in the pH of respiratory secretions; and impaired neutrophil phagocytic function. The available data suggest that proton pump inhibitors play a role in the increased frequency of bacterial pneumonia in treated patients. Similar data implicating H2 receptor antagonists and the proposed mechanism (acid suppression) imply that there are no alternative acid-suppressive medications. This risk of pneumonia is yet another reason not to trivialise the use of proton pump inhibitors. These drugs should only be used when the likely benefits clearly outweigh the potential harms.

Links

Source

Prescrire international 21:130 2012 Sep pg 210-2

MeSH

Anti-Ulcer Agents
Community-Acquired Infections
Cross Infection
Drug Administration Schedule
Evidence-Based Medicine
Histamine H2 Antagonists
Humans
Odds Ratio
Pneumonia, Bacterial
Proton Pump Inhibitors
Risk Assessment
Risk Factors
Time Factors

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

23016253

Citation

"Proton Pump Inhibitors: Bacterial Pneumonia." Prescrire International, vol. 21, no. 130, 2012, pp. 210-2.
Proton pump inhibitors: bacterial pneumonia. Prescrire Int. 2012;21(130):210-2.
(2012). Proton pump inhibitors: bacterial pneumonia. Prescrire International, 21(130), pp. 210-2.
Proton Pump Inhibitors: Bacterial Pneumonia. Prescrire Int. 2012;21(130):210-2. PubMed PMID: 23016253.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proton pump inhibitors: bacterial pneumonia. PY - 2012/9/29/entrez PY - 2012/9/29/pubmed PY - 2012/10/24/medline SP - 210 EP - 2 JF - Prescrire international JO - Prescrire Int VL - 21 IS - 130 N2 - After two decades of widespread use, proton pump inhibitors are considered to have a very well-documented and acceptable adverse effect profile in the short-term. Yet adverse effects continue to emerge. In particular, epidemiological studies conducted over the past 10-12 years showed an increased incidence of fractures. New data now point to an increased risk of bacterial pneumonia. A Korean meta-analysis published in 2011 showed a statistically significant increase in the risk of bacterial pneumonia in patients taking proton pump inhibitors, with an odds ratio of 1.27 (95% confidence interval (95% CI): 1.11 to 1.46). The increase in community-acquired pneumonia was also statistically significant, with an odds ratio of 1.34 (95% CI: 1.14 to 1.57). This is consistent with the results of a meta-analysis published in 2010, which gave an odds ratio of 1.36 (95% CI: 1.12 to 1.65). The increase in the frequency of bacterial pneumonia was highest during the first week of treatment, with an odds ratio of 3.95 (95% CI: 2.86 to 5.45). Subsequent studies have provided conflicting results. Possible mechanisms include bacterial passage into the lungs after colonisation of the upper gastrointestinal tract resulting from the reduction in gastric acidity; bacterial overgrowth in the lungs due to a change in the pH of respiratory secretions; and impaired neutrophil phagocytic function. The available data suggest that proton pump inhibitors play a role in the increased frequency of bacterial pneumonia in treated patients. Similar data implicating H2 receptor antagonists and the proposed mechanism (acid suppression) imply that there are no alternative acid-suppressive medications. This risk of pneumonia is yet another reason not to trivialise the use of proton pump inhibitors. These drugs should only be used when the likely benefits clearly outweigh the potential harms. SN - 1167-7422 UR - https://www.unboundmedicine.com/medline/citation/23016253/Proton_pump_inhibitors:_bacterial_pneumonia_ DB - PRIME DP - Unbound Medicine ER -