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Acid inhibition and infections outside the gastrointestinal tract

Nimish Vakil1

  • 1University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA. nvakil@facstaff.wisc.edu

The American Journal of Gastroenterology
|March 6, 2009
PubMed

Insights

Acid-inhibiting drugs may increase pneumonia risk by altering stomach flora. Doctors should carefully consider prescribing these agents, like histamine-2 receptor antagonists and proton pump inhibitors, for at-risk patients.

Area of Science:

  • Medical Science
  • Pharmacology
  • Infectious Disease

Background:

  • Acid-inhibitory agents, including histamine-2 receptor antagonists and proton pump inhibitors, can alter gastric flora.
  • Epidemiologic and microbiologic studies suggest a potential link between these agents and pneumonia development.
  • Gastric colonization by microorganisms is a plausible mechanism, particularly in mechanically ventilated patients.

Purpose of the Study:

  • To review the association between acid-inhibitory agents and pneumonia.
  • To discuss the biological plausibility of this association.
  • To provide clinical guidance for prescribing these agents to at-risk individuals.

Main Methods:

  • Review of existing epidemiologic and microbiologic studies.
  • Analysis of the biological mechanisms linking acid suppression to altered gastric flora and potential pneumonia.
  • Clinical risk assessment for patients requiring acid inhibition.

Main Results:

  • Some studies show an association between acid inhibitor use and pneumonia, but data for community-acquired pneumonias are not conclusive.
  • Gastric colonization in patients using acid suppressive agents may predispose to Gram-negative pneumonias, especially in mechanically ventilated individuals.
  • Elderly patients with chronic lung disease, those on immunosuppressants or corticosteroids, and patients with recurrent infections are at higher risk.

Conclusions:

  • The use of acid-inhibitory agents warrants careful consideration in patients at risk for pneumonia.
  • Prudent prescribing practices should weigh the benefits of acid inhibition against the potential increased risk of pneumonia.
  • Further conclusive research is needed, particularly for community-acquired pneumonias.

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