Acid inhibition and infections outside the gastrointestinal tract.
Acid-inhibitory agents can alter the flora of the stomach, and epidemiologic studies suggest an association between the use of these agents and the development of pneumonia. Microbiologic studies suggest that a causal association may be biologically plausible because gastric colonization with organisms can occur in patients taking acid suppressive agents. In mechanically ventilated patients, colonization of the oropharynx and stomach may predispose to Gram-negative pneumonias. Despite the associations between acid inhibitor use and pneumonia shown in some studies, the data on community-acquired pneumonias are not conclusive. In clinical practice, prudence would dictate that the need for acid inhibition with histamine-2 receptor antagonists or proton pump inhibitors should be carefully considered in patients who are at risk for pneumonias (elderly patients with chronic lung disease who are on immunosuppressive drugs or corticosteroids and patients with recurrent lung infections requiring frequent antibiotic therapy).
Vakil
Nimish
N
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA. nvakil@facstaff.wisc.edu
D017714:Community-Acquired Infections; D005744:Gastric Acid / Q000378:metabolism; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000382:microbiology; D016905:Gram-Negative Bacterial Infections / Q000209:etiology; D006635:Histamine H2 Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D009960:Oropharynx / Q000382:microbiology; D018410:Pneumonia, Bacterial / Q000209:etiology*; D054328:Proton Pump Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000009:adverse effects; D012307:Risk Factors; D013270:Stomach / Q000382:microbiology*
D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors