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Do Gastric Acid–Suppressing Drugs Increase Risk for Community-Acquired Pneumonia?

Summary and Comment |
November 12, 2013

Do Gastric Acid–Suppressing Drugs Increase Risk for Community-Acquired Pneumonia?

  1. David A. Johnson, MD

Contrary to previous observational study findings, no association was observed.

  1. David A. Johnson, MD

Results of observational studies suggest an elevated risk for hospitalization for community-acquired pneumonia (CAP) in patients using proton-pump inhibitors (PPIs). The hypothesis is that the alteration of gastric pH leads to diminished bactericidal protection and, consequently, increased risk for infection. However, as the patients in those studies were often taking PPIs for gastroesophageal reflux disease (GERD), which itself is an independent risk factor for CAP, the results may have been biased toward a positive association due to uncontrolled confounding.

In the current study, investigators specifically selected patients who were prescribed PPIs for a non-GERD indication — prevention of complications associated with use of nonsteroidal anti-inflammatory drugs (NSAIDs) — in order to minimize potential bias. They identified eight cohorts of new users of NSAIDS from population-based Canadian databases and used propensity scores to estimate the odds of acquiring CAP at 6 months. A fixed effects model was used to estimate the impact across databases.

Of 4,238,504 new users of NSAIDs, 96,870 (2.3%) used a concomitant PPI. The cumulative 6-month incidence of CAP did not differ between PPI users (0.17%) and nonusers (0.12%). The cumulative 6-month incidence also did not differ between users of histamine-2 receptor antagonists (0.16%) and nonusers (0.12%).

Comment

This study's patient population was specifically chosen to minimize confounding from gastroesophageal reflux disease–related pneumonia risk. These findings should refute the global proposition that gastric acid inhibitors are associated with an increased risk for community-acquired pneumonia. Moreover, the lack of association observed for both proton-pump inhibitors and the less-potent histamine-2 receptor antagonists suggests that potency of gastric acid suppression does not affect the risk for CAP.

  • Disclosures for David A. Johnson, MD at time of publication Consultant / Advisory board Abbott; Centacor; CRH Medical; Medscape; Pfizer; Takeda Pharmaceuticals Speaker's bureau Takeda Pharmaceuticals Editorial boards ACG Universe; MedScape Gastroenterology

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