An estimated 33,000 deaths a year from hospital-acquired
pneumonia may result from the practice of routinely prescribing
proton pump inhibitors and other acid-suppressing drugs during
hospitalization to patients who don't need them.
Use of acid-reducing drugs was associated with a 30% increased
risk for developing pneumonia in a newly reported study.
The drugs are typically given to reduce the risk of stress-related
ulcers, which can be life threatening. But they are often
prescribed to patients with a very low risk for developing
the ulcers, says study researcher Shoshana J. Herzig, MD,
of Beth Israel Deaconess Medical Center and Harvard School
Use of proton pump inhibitors (PPIs) has been associated
with a slight increase in community-acquired pneumonia risk
in several recent studies. But the new research is the first
to explore a possible link in hospitalized patients who don't
require a ventilator to breathe and are treated outside intensive
care units (ICUs).
The study appears in the May 27 issue of TheJournal of the
American Medical Association.
"In our study, the risk to the individual patient was
small," Herzig tells WebMD. "But because so many
people are hospitalized each year, the number of patients
involved is not insignificant."
Hospital Patients and PPIs
Previous studies suggest that acid-suppressing medications
are prescribed to between 40% and 70% of hospitalized patients
in the U.S.
Herzig and colleagues reviewed the medical records of almost
64,000 non-ventilated, non-ICU adult patients hospitalized
and treated at Beth Israel Deaconess between 2004 and 2007
and found that 52% were prescribed acid-reducing drugs.
Of these, 83% were prescribed proton pump inhibitors and
23% received another class of acid-suppressives known as H2
blockers. Examples of PPIs include Aciphex, Nexium, Prevacid,
Prilosec, and Protonix. H2 blockers include Axid, Pepcid,
Tagamet, and Zantac.
In nine out of 10 cases the drugs were prescribed within
48 hours of admission.
The review of patient records revealed that:
* 3.5% of patients developed hospital-acquired pneumonia.
* After adjusting for other risk factors for pneumonia, use
of acid-suppression drugs was associated with a 30% increased
risk for developing hospital-acquired pneumonia.
* The association was statistically significant for proton
pump inhibitors, but not for H2 blockers.
Some 40 million patients are discharged from the hospital
in the U.S. each year, and roughly one in five patients who
develop hospital-acquired pneumonia die as a result.
Assuming that 50% of hospitalized patients are prescribed
acid-suppressing drugs, Herzig and colleagues estimate that
180,000 cases of hospital-acquired pneumonia and 33,000 deaths
each year may be due to their use.
The researchers conclude that the routine use of acid-suppressing
drugs in non-ventilated, non ICU-treated patients with a low
risk for developing stress ulcers should be re-examined.