Some Acid-Reflux Drugs Tied to Pneumonia

A growing number of hospital patients are routinely given drugs to prevent acid reflux. But a new study has found that patients who take these so-called proton pump inhibitors are at higher risk for pneumonia than those who do not.

The drugs — including Nexium, Prilosec and Prevacid — are often recommended for intensive-care patients to prevent stress ulcers, and in recent years they have been given to many other hospital patients, in large part because they are widely perceived to be safe. Experts estimate that 40 percent to 70 percent of inpatients now receive acid-suppressive drugs during a hospital stay, with about half receiving them for the first time.

“I noticed that there were a lot of patients being placed on these for prophylactic purposes, and I thought that was curious because they are not currently recommended for patients who aren’t at high risk for stress ulcers,” said the study’s lead author, Dr. Shoshana J. Herzig, chief medical resident at Beth Israel Deaconess Medical Center in Boston, explaining why she was interested in the subject.

Dr. Herzig said that proton pump inhibitors, which suppress acid in the stomach, might promote the growth of different types of bacteria in the upper gastrointestinal and respiratory tract, and that those bacteria might be the culprits in the pneumonias. Another explanation, she suggested, may be that acid stimulates coughing, and coughing less may promote pneumonia.

The study, published in The Journal of the American Medical Association this week, analyzed 63,878 admissions to Beth Israel Deaconess from Jan. 1, 2004, to Dec. 31, 2007. All of the records belonged to adults hospitalized for three days or more, who had not been in intensive care. Acid-suppressive drugs were ordered for just over half of the patients.

Among patients who received the drugs, 4.9 percent developed pneumonia in the hospital — more than double the 2 percent who had not been given the drugs. After adjusting to account for the fact that recipients of the drugs may have been sicker to begin with, the researchers determined that patients treated with acid-reflux drugs faced a 30 percent increase in pneumonia risk over patients who were not.

The increase in pneumonia was not seen among patients who took a type of acid-reflux drug known as histamine-2 receptor antagonists, sold under names like Pepcid and Zantac.

A spokesman for AstraZeneca, which makes Nexium, also known as “the purple pill,” said the study had limitations and could not definitively show that the drug caused excess pneumonia.
Earlier reports have linked proton pump inhibitors to other complications, including community-acquired pneumonia, hip fractures and diarrhea associated with Clostridium difficile.

Although the drugs are used to prevent stress ulcers, “a lot of people don’t need to be on them in the first place, and they’re sent home on them and stay on them,” said Dr. Joel J. Heidelbaugh of the University of Michigan. He added that such inappropriate use of the drugs drove up the costs of health care.

This article was written by Roni Caryn Rabin of the New York Times
http://www.nytimes.com/2009/05/27/health/27drugs.html?ref=health

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