Routine use in hospitalized patients should be re-evaluated, experts say
TUESDAY, May 26 (HealthDay News) -- Instead of helping them get better faster, giving acid-suppressing medications to many hospital patients actually increases their risk of developing pneumonia while in the hospital, new research suggests.
In critically ill hospital patients, the medications have been shown to prevent serious gastrointestinal problems caused by the physical stress of illness. And, because the potential for benefit seemed clear and the risk of side effects appeared low, use of the drugs also became commonplace in patients who were not in intensive or critical care.
This oft-used practice, though, has been questioned by a study in the May 27 issue of the Journal of the American Medical Association. It found that acid suppressors might not be as benign as once believed.
In fact, after reviewing the records of nearly 65,000 people who were hospitalized, the researchers found that the rate of hospital-acquired pneumonia was 30 percent higher among people on acid-suppressing medications.
"What we found after controlling for other factors is that there was an association between acid-suppressive medications and hospital-acquired pneumonia," said study author Dr. Shoshana Herzig, chief medical resident and a general medical fellow at Beth Israel Deaconess Medical Center and an instructor in medicine at Harvard Medical School.
Two different classes of medications can reduce acid in the stomach. One class, called proton pump inhibitors (PPIs), blocks acid from being pumped into the stomach, according to Dr. Mitchell Cappell, chief of gastroenterology at William Beaumont Hospital in Royal Oak, Mich. The other class, commonly referred to as H2 blockers, also decreases acid in the stomach but is not as effective at reducing acid as a proton pump inhibitor. Both classes of medications are sold as prescription drugs and over-the-counter medicines.
Herzig and her colleagues reviewed data from hospital admissions from 2004 to 2007. All patients included in the study were hospitalized for at least three days, and none were in intensive care units.
Just over half -- 52 percent -- received some sort of acid-suppressing medication to help prevent stress ulcers while they were hospitalized.
After adjusting the data to account for numerous factors -- including the severity and type of illness, whether the hospitalization was for an elective procedure or an urgent condition, and more -- the researchers found that the risk of developing pneumonia in the hospital was 30 percent higher for those on acid blockers.
In a small sub-analysis, the researchers tried to assess the effect of PPIs vs. H2 blockers. Although the analysis suggested that H2 blockers did not increase the risk significantly, Herzig said there were not enough people in the study on both medications for the researchers to reach a definitive, statistically significant conclusion.
She said that several theories might explain how the medications seem to increase the risk of pneumonia.
- By suppressing acid, more bacteria might be able to flourish and travel to the lungs.
- Acid might stimulate the cough response, which is one of the body's ways of clearing infectious agents.
- Acid-suppressive medications might depress immune function.
"I think we have to address whether acid-suppressors should be used in every patient," Cappell said. "They cost money, they have side effects and they're being used all the time for very weak reasons."
However, he said, it's important for people to realize that even though the risk of hospital-acquired pneumonia was increased with acid-suppressors, the overall risk remains low. He said the study's findings also need to be confirmed with additional research.
"Even an uncommon side effect can occur when drugs are used in a lot of people," he said. "I think we have to be careful and not use these drugs indiscriminately."
Both doctors said that anyone taking the drugs for medical conditions such as gastroesophageal reflux disease (GERD) need not be concerned. "These findings really just apply to patients who are hospitalized and who are on these medications in the absence of a clear indication for them," Herzig said. Her advice: "Don't stop taking your medications. Discuss any concerns with your physician."
But, for people who are hospitalized, she said, "I think doctors should reconsider the routine prophylactic use of acid-suppressive medications for patients at low risk of stress ulcers."
The U.S. National Library of Medicine has more on hospital-acquired pneumonia.
By Serena Gordon
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