Acid-Suppressive Therapy and Risk of Infections: Pros and Cons

Published on Mar 30, 2017in Clinical Drug Investigation2.267
· DOI :10.1007/S40261-017-0519-Y
Leon Fisher4
Estimated H-index: 4
(Frankston Hospital),
Alexander Fisher12
Estimated H-index: 12
(Canberra Hospital),
Alexander Fisher12
Estimated H-index: 12
(ANU: Australian National University)
Sources
Abstract
This narrative review summarises the benefits, risks and appropriate use of acid-suppressing drugs (ASDs), proton pump inhibitors and histamine-2 receptor antagonists, advocating a rationale balanced and individualised approach aimed to minimise any serious adverse consequences. It focuses on current controversies on the potential of ASDs to contribute to infections—bacterial, parasitic, fungal, protozoan and viral, particularly in the elderly, comprehensively and critically discusses the growing body of observational literature linking ASD use to a variety of enteric, respiratory, skin and systemic infectious diseases and complications (Clostridium difficile diarrhoea, pneumonia, spontaneous bacterial peritonitis, septicaemia and other). The proposed pathogenic mechanisms of ASD-associated infections (related and unrelated to the inhibition of gastric acid secretion, alterations of the gut microbiome and immunity), and drug-drug interactions are also described. Both probiotics use and correcting vitamin D status may have a significant protective effect decreasing the incidence of ASD-associated infections, especially in the elderly. Despite the limitations of the existing data, the importance of individualised therapy and caution in long-term ASD use considering the balance of benefits and potential harms, factors that may predispose to and actions that may prevent/attenuate adverse effects is evident. A six-step practical algorithm for ASD therapy based on the best available evidence is presented.
📖 Papers frequently viewed together
1 Citations
2017
2 Authors (Ricardo J. José, ..., Maria Mouyis)
References751
Newest
#1Nicole T. Shen (Cornell University)H-Index: 9
#2Anna M. Maw (University of Colorado Denver)H-Index: 8
Last. Arthur T. Evans (SHM: Society of Hospital Medicine)H-Index: 46
view all 8 authors...
Background & Aims Systematic reviews have provided evidence for the efficacy of probiotics in preventing Clostridium difficile infection (CDI), but guidelines do not recommend probiotic use for prevention of CDI. We performed an updated systematic review to help guide clinical practice. Methods We searched MEDLINE, EMBASE, International Journal of Probiotics and Prebiotics , and The Cochrane Library databases for randomized controlled trials evaluating use of probiotics and CDI in hospitalized a...
137 CitationsSource
#1Kristen Cares (Boston Children's Hospital)H-Index: 2
#2Namir Al-AnsariH-Index: 2
Last. Mohammad El-BabaH-Index: 7
view all 8 authors...
BACKGROUND: Some theorize that prolonged use of proton pump inhibitors (PPIs) may increase the risk of small intestinal bacterial overgrowth (SIBO). Chronic acid suppression and resultant hypochlorhydria may lead to an altered intraluminal environment, which, in turn, may promote the growth of bacteria in the small intestine. A handful of studies measured the risk of SIBO in adults taking PPIs and obtained mixed results; however, this risk has not been exclusively measured in children. AIM: This...
16 CitationsSource
#1Pratik P. Rane (UH: University of Houston)H-Index: 5
#2Sushovan Guha (University of Texas MD Anderson Cancer Center)H-Index: 51
Last. Rajender R. Aparasu (UH: University of Houston)H-Index: 27
view all 4 authors...
Abstract Background Proton pump inhibitors (PPIs) can lead to several adverse effects among the elderly, particularly when used inappropriately or in contrast to evidence suggested protocols. Objective The aim of this study was to examine the prevalence and predictors of non-evidence based PPI use in elderly nursing home residents. Methods A cross-sectional study was conducted using data from the 2004 National Nursing Home Survey (NNHS). The study sample included nursing home residents 65 years ...
33 CitationsSource
Levothyroxine therapy and impaired clearance are the strongest contributors to small intestinal bacterial overgrowth: Results of a retrospective cohort study
10 CitationsSource
#1Man YangH-Index: 12
#1Man YangH-Index: 2
Last. Ping-Guang LeiH-Index: 2
view all 9 authors...
AbstractObjective: Proton pump inhibitors (PPIs) are recommended for preventing gastrointestinal lesions induced by non-steroidal anti-inflammatory drugs (NSAIDs). We performed this study: (1) to evaluate the effectiveness and safety of PPIs, (2) to explore the association between effectiveness and potential influential factors, and (3) to investigate the comparative effect of different PPIs.Methods: MEDLINE, EMBASE, and the Cochrane Library were searched to identify randomized controlled trials...
13 CitationsSource
#1Daniel S. Strand (UVA: University of Virginia)H-Index: 11
#2Daejin KimH-Index: 1
Last. David A. Peura (UVA: University of Virginia)H-Index: 33
view all 3 authors...
Proton pump inhibitors (PPIs) were clinically introduced more than 25 years ago and have since proven to be invaluable, safe, and effective agents for the management of a variety of acid-related disorders. Although all members in this class act in a similar fashion, inhibiting active parietal cell acid secretion, there are slight differences among PPIs relating to their pharmacokinetic properties, metabolism, and Food and Drug Administration (FDA)-approved clinical indications. Nevertheless, eac...
158 CitationsSource
#1Nobuhiko AraiH-Index: 4
#2Tomoki NakamizoH-Index: 15
Last. Hiromichi MiyazakiH-Index: 5
view all 7 authors...
Background Although histamine H2-blockers (H2B) and proton pump inhibitors (PPI) are used commonly to prevent gastrointestinal bleeding in acute stroke, they are implicated in the increased risk of pneumonia in other disease populations. In acute stroke, the presence of distinctive risk factors of pneumonia, including dysphagia and impaired consciousness, makes inclusive analysis vulnerable to confounding. Our aim was to assess whether acid-suppressive drugs increase pneumonia in acute stroke in...
19 CitationsSource
#1Chia-Fen Tsai (NYMU: National Yang-Ming University)H-Index: 21
#2Mu-Hong Chen (NYMU: National Yang-Ming University)H-Index: 31
Last. Ching-Liang LuH-Index: 35
view all 10 authors...
Background & Aims Hepatic encephalopathy (HE) is a serious complication of cirrhosis and is associated with gut dysbiosis. Proton pump inhibitors (PPIs), frequently prescribed to patients with cirrhosis, can contribute to small-bowel bacterial overgrowth. We investigated whether PPI predisposes patients with cirrhosis to HE using a large database of patients. Methods We performed a case–control study nested within a sample of Taiwan National Health Insurance beneficiaries (n = 1,000,000), follow...
90 CitationsSource
#1An Tran-Duy (UM: Maastricht University)H-Index: 12
#2Bart Spaetgens (UM: Maastricht University)H-Index: 9
Last. Coen D.A. Stehouwer (UM: Maastricht University)H-Index: 140
view all 5 authors...
Background & Aims There have been increasing numbers of case reports and observational studies of adverse events in patients receiving long-term therapy with proton pump inhibitors (PPIs). The effects of PPI therapy on risks of fundic gland polyps (FGPs) and gastric cancer have received considerable attention. We performed a systematic review with a meta-analysis of randomized controlled trials and observational studies that assessed these risks. Methods We searched the PUBMED, EMBASE, and Cochr...
91 CitationsSource
#1Carmelo Scarpignato (University of Parma)H-Index: 46
#2Luigi Gatta (University of Parma)H-Index: 28
Last. Corrado Blandizzi (UniPi: University of Pisa)H-Index: 54
view all 4 authors...
Background The introduction of proton pump inhibitors (PPIs) into clinical practice has revolutionized the management of acid-related diseases. Studies in primary care and emergency settings suggest that PPIs are frequently prescribed for inappropriate indications or for indications where their use offers little benefit. Inappropriate PPI use is a matter of great concern, especially in the elderly, who are often affected by multiple comorbidities and are taking multiple medications, and are thus...
154 CitationsSource
Cited By13
Newest
#1Zahari Vinarov (Katholieke Universiteit Leuven)H-Index: 10
#1Zahari Vinarov (Sofia University)
Last. Patrick Augustijns (Katholieke Universiteit Leuven)H-Index: 74
view all 25 authors...
ABSTRACT The absorption of oral drugs is frequently plagued by significant variability with potentially serious therapeutic consequences. The source of variability can be traced back to interindividual variability in physiology, differences in special populations (age- and disease-dependent), drug and formulation properties, or food-drug interactions. Clinical evidence for the impact of some of these factors on drug pharmacokinetic variability is mounting: e.g. gastric pH and emptying time, smal...
8 CitationsSource
#1Jan Homolak (University of Zagreb)H-Index: 6
#2Ivan Kodvanj (University of Zagreb)H-Index: 3
Last. Vladimir Trkulja (University of Zagreb)H-Index: 18
view all 3 authors...
Source
#1Issac E. Perry (Georgia Regents University)H-Index: 1
#2Irene Sonu (Stanford University)H-Index: 6
Last. Kenneth J. Vega (Georgia Regents University)H-Index: 2
view all 6 authors...
Proton pump inhibitors (PPIs) are one of the most common medications taken by patients worldwide. PPIs are used to treat acid-related disorders, including gastroesophageal reflux disease, peptic ulcer disease, Helicobacter pylori infection, and nonsteroidal anti-inflammatory drug/stress ulceration. For some of these diseases, long-term treatment is necessary. With such prolonged use, concern and investigation into potential adverse effects has increased. In addition, data are available regarding...
4 CitationsSource
#1Mohammad Rababa (JUST: Jordan University of Science and Technology)H-Index: 5
#2Abeer M Rababa'h (JUST: Jordan University of Science and Technology)H-Index: 10
Proton pump inhibitors (PPIs) are effective in treating gastroesophageal reflux, peptic ulcers, and esophagitis. However, the long-term use of PPIs by older adults is associated with adverse health outcomes. There is limited evidence about older adults’ awareness of long-term PPI use and its associated adverse effects. This study aimed to assess older adults’ awareness of the adverse effects of the long-term use of PPIs, and their willingness to stop PPI use given of the risks and benefits of PP...
Source
#1Bruno CharpiatH-Index: 14
#2Nathalie Bleyzac (UCBL: Claude Bernard University Lyon 1)H-Index: 19
Last. Michel Tod (UCBL: Claude Bernard University Lyon 1)H-Index: 11
view all 3 authors...
During the ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), more attention should be paid to the balance of risks and benefits associated with proton pump inhibitors for the following reasons. One of the main functions of gastric juice is to inactivate swallowed microorganisms, thereby inhibiting infectious agents from reaching the intestine. Studies have documented that proton pump inhibitors are a risk factor for rotavirus, influenza virus, norovirus, and Middl...
10 CitationsSource
#1Tom C. Martinsen (NTNU: Norwegian University of Science and Technology)H-Index: 14
#2Reidar Fossmark (NTNU: Norwegian University of Science and Technology)H-Index: 24
Last. Helge L. Waldum (NTNU: Norwegian University of Science and Technology)H-Index: 61
view all 3 authors...
Gastric juice is a unique combination of hydrochloric acid (HCl), lipase, and pepsin. Acidic gastric juice is found in all vertebrates, and its main function is to inactivate microorganisms. The phylogenetic preservation of this energy-consuming and, at times, hazardous function (acid-related diseases) reflects its biological importance. Proton pump inhibitors (PPIs) are one of the most widely used drugs in the world. Due to the reduced prevalence of Helicobacter pylori infection as well as the ...
12 CitationsSource
#1Hao-Jie Zhong (Guangdong Pharmaceutical University)H-Index: 1
#2Da Lin (Guangdong Pharmaceutical University)H-Index: 1
Last. Yu Chen (Guangdong Pharmaceutical University)H-Index: 1
view all 5 authors...
WHAT IS KNOWN AND OBJECTIVE: Mounting evidence suggests that long-term use of gastric-acid suppressants (GASs) may be associated with adverse effects. Whether GAS use increases the risk of enteric peritonitis in patients undergoing peritoneal dialysis (PD) is not known. The aim of this meta-analysis was to evaluate the association between GAS use and enteric peritonitis in PD patients. METHODS: We searched PubMed, Embase and Cochrane Library databases from inception to 23 January 2018 to identif...
5 CitationsSource
: Proton pump inhibitors (PPIs) are commonly used as a supplement to cancer therapy. Yet, their effect on cancer mortality is largely unknown. Using data from Danish nationwide registries and Cox models regressing of both propensity scores and drug use, we estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for cancer-specific and noncancer death among PPI users (≥2 prescriptions within six months after diagnosis; n = 36,066) compared with nonusers (<2 prescriptions, n = 311,853) o...
13 CitationsSource
#1Troy Watson (Hospital Corporation of America)H-Index: 1
#2Jason Hickok (Hospital Corporation of America)H-Index: 13
Last. Edward Septimus (Hospital Corporation of America)H-Index: 37
view all 6 authors...
: In this multicenter retrospective cohort study of over 1 million patients at 150 US hospitals, proton pump inhibitors increased the odds of a patient having hospital-onset Clostridium difficile infection as did third and fourth generation cephalosporins, carbapenems, and piperacillin/tazobactam. These findings support appropriate prescribing of acid-suppression therapy and high-risk antibiotics.
11 CitationsSource
#1Pablo Roman (UAL: University of Almería)H-Index: 8
#2Raquel Abalo (URJC: King Juan Carlos University)H-Index: 20
Last. Diana Cardona (UAL: University of Almería)H-Index: 16
view all 4 authors...
In recent years, interest in the relationship between gut microbiota and disease states has grown considerably. Indeed, several strategies have been employed to modify the microbiome through the administration of different diets, by the administration of antibiotics or probiotics, or even by transplantation of feces. In the present manuscript, we focus specifically on the potential application of probiotics, which seem to be a safe strategy, in the management of digestive, pain, and emotional di...
8 CitationsSource