A recent study suggests that caution should be exercised when prescribing acid-suppressive drugs for patients at risk for pneumonia, said Clinical Advisor. Use of proton pump inhibitors (PPI), such as Nexium, Prilosec, and Prevacid, or histamine2 (H2) receptor antagonists, such as Axid, Pepcid, Tagamet, and Zantac, could increase risks for pneumonia.
Chun-Sick Eom, MD, MPH, and colleagues reviewed conflicting findings from earlier studies on PPI health problems and side effects of other acid-suppressive medications with regard to increased pneumonia risks. The meta-analysis of eight observational studies revealed that the overall risk for histamine 2 receptor antagonists and PPIs and pneumonia is 27 percent increased in PPI users and 22 percent increased for those taking H2 receptor antagonists, said Clinical Advisor. Also, 23 randomized controlled trials found a 22 percent increased risk for developing hospital-acquired pneumonia for people taking H2 receptor antagonists, added Clinical Advisor.
Based on current use of these medications, Dr. Eom’s team determined that a 24-25 cases of pneumonia can be expected for every 1,000 patients taking these medications. “Given that 40 to 70 percent of patients admitted to the hospital receive acid-suppressive drugs, a considerable burden of morbidity and mortality of hospital-acquired pneumonia may be attributable to this type of therapy,” the authors wrote in an online report published in the Canadian Medical Association Journal, quoted Clinical Advisor. “In the context of community-acquired pneumonia, the impact of these drugs could be even more serious,” the researchers noted.
The team is advising physicians to cautiously consider the prescription of heartburn drugs, specifically for those patients at a higher risk for pneumonia. “Since it is unnecessary to achieve an achlorhydric state in order to resolve symptoms, we recommend using the optimal effective dose of the drug necessary to achieve desired therapeutic goals,” the investigators stated, quoted Clinical Advisor.
PPIs, available by prescription and over-the-counter (OTC), work by reducing the amount of acid in the stomach, and are approved to treat conditions such as gastroesophageal reflux disease (GERD), stomach and small intestine ulcers, and inflammation of the esophagus. Prescription versions of the drugs include Nexium, Dexilant, Prilosec, Zegerid, Prevacid, Protonix, and Aciphex. OTC brands include Prilosec OTC, Zegerid OTC and Prevacid 24HR. Since their introduction in the 90s, PPIs have ranked among the top selling drugs, with doctors writing 119 million prescriptions for them last year alone.
Histamine-2 receptor antagonists include drugs like Tagamet, Pepcid, Axid and Zantac. PPIs and histamine-2 receptor antagonists suppress stomach acid, which protects the body from many types of microbes. While the drugs relieve gastrointestinal stress, they do leave users open to infections.
A new study suggests that taking PPIs could increase the risk of another PPI Side Effect “Clostridium difficile associated diarrhea (CDAD)” by as much as 80 percent. C. difficile represents an escalating threat to public health, and CDAD cost the U.S. an estimated $3 billion in 2005.