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Early Use of Proton Pump Inhibitors Increases Risk of Upper Respiratory Tract Infections in Children: A Birth Cohort

Maite Rojas-McKenzie1, Juan P Fraga1, Carolina Iturriaga1

  • 1Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.

Pediatric Pulmonology
|June 26, 2026
PubMed

Insights

Infant proton pump inhibitor (PPI) use is linked to increased risks of upper respiratory tract infections (RTIs), hospitalizations, and antibiotic use. Healthcare providers should exercise caution when prescribing PPIs to infants due to potential adverse effects on immune development.

Area of Science:

  • Pediatric Gastroenterology
  • Infectious Diseases
  • Clinical Pharmacology

Background:

  • Proton pump inhibitors (PPIs) are commonly prescribed for infant gastrointestinal issues.
  • Evidence supporting PPI efficacy and safety in infants is limited.
  • Potential risks associated with early PPI exposure warrant investigation.

Purpose of the Study:

  • To investigate the association between early proton pump inhibitor (PPI) exposure and respiratory tract infections (RTIs) in infants.
  • To analyze the impact of PPI use within the first six months of life on RTI incidence.
  • To evaluate the relationship between PPI exposure and specific types of RTIs and related healthcare utilization.

Main Methods:

  • A birth cohort study (ARIES) followed 200 children from birth to 24 months.
  • Early PPI exposure was defined as use within the first 6 months.
  • Logistic regression models were used to assess associations between PPI exposure and RTIs.

Main Results:

  • Early PPI exposure was significantly associated with increased odds of otitis media, viral croup, RTI-related hospitalization, and antibiotic use.
  • Any PPI exposure throughout the first 24 months also showed increased odds for these upper RTIs.
  • No significant associations were found between PPI use and lower respiratory tract infections.

Conclusions:

  • Early infant exposure to proton pump inhibitors is linked to a higher risk of upper respiratory tract infections.
  • Findings highlight the need for judicious PPI prescribing in infants.
  • This period is critical for immune and microbiota development, emphasizing cautious medication use.
Abstract

Keywords:
gastroesophageal refluxinfantile colicinfantsotitis mediaviral croup

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