Use of Acid-Suppressive Medications Associated With Increased Risk of Hospital-Acquired Pneumonia

According to a new study published in JAMA, hospitalized patients who receive acid-suppressive medication (such as Proton Pump Inhibitors [PPIs] and H2 blockers) have a 30 percent increased risk of developing pneumonia while in the hospital than other patients.

Acid-suppressive medication have been prescribed primarily in the treatment of gastroesophageal reflux disease (GERD) and ulcers. It is estimated that between 40 percent and 70 percent of hospitalized patients receive some form of acid-suppressive medication. According to background information in the JAMA article, one of the concerns that has risen with the high usage among hospitalized patients involves indications that these medications may be prescribed when there isn't a medical need, such as the patient not having either GERD or a peptic ulcer. Also, there is data suggesting an increased risk for community-acquired pneumonia in outpatients because of possible over-prescribing of acid-suppressive medication.

Shoshana J. Herzig, M.D., of Beth Israel Deaconess Medical Center, Boston, and colleagues examined the association between acid-suppressive medication use and hospital-acquired pneumonia. The study included data on patients who were admitted to a large, urban, academic medical center from January 2004 through December 2007, including patients who were at least 18 years of age, hospitalized for 3 or more days, and not admitted to the intensive care unit. Acid-suppressive medication use was defined as any order for a PPI or H2 blocker. The study included data on 63,878 hospital admissions.

Overall, acid-suppressive medication was ordered in 32,922 admissions (52 percent). Of the group who received these medications, 27,236 (83 percent) received PPIs and 7,548 (23 percent) received H2 blockers, with some exposed to both medications. The majority of these medications were ordered within 48 hours of admission (89 percent).

The research indicated the incidence of hospital-acquired pneumonia was higher in the group given an acid-suppressive medication than the group not given an acid-suppressive medication (4.9 percent vs. 2.0 percent). Patients receiving acid-suppressive medications had a 30 percent increased risk of hospital-acquired pneumonia. The association was significant for proton-pump inhibitors but not for H2 blockers.

Why the increase risk of developing pneumonia? Researchers reported that acid-suppressive medications have been thought to increase the risk of pneumonia via modification of upper gastrointestinal bacteria, and, as a result, respiratory bacteria.

Free abstract of this research.