JAMA article relates increased risk of pneumonia to acid-reflux drugs

The Journal of the American Medical Association today published an article disclosing research that ties the routine, prophylactic use of acid-reflux drugs to an increased risk of pneumonia in hospitalized patients.  The study followed more than 63,000 patients at Beth Israel Deaconess Hospital for three years.  The drugs involved, so-called proton pump inhibitors, including Nexium, Prilosec and Prevacid, are given to an estimated 40-70 percent of hospitalized patients, with about one-half receiving them for the first time.  They are intended to prevent the development of stress ulcers, but are not currently recommended for patients who are not at high risk.

Th doctor who supervised the study speculated that by suppressing stomach acid, the medicines may promote the growth of bacteria in the upper gastrointestinal and respiratory tracts, and this bacteria may contribute to an increased likelihood of pneumonia.  Similarly, she theorized that the presence of stomach acid in unmedicated patients may promote coughing which helps to guard against the development of pneumonia.

Two percent of patients not given a proton-pump inhibitor developed pneumonia in the hospital, while 4.9 percent of patients given the medicine developed pneumonia.  A statistically significant increase in pneumonia was not observed in patients who were adminstered histamine-2 receptor antagonists, such as Pepcid and Zantac.