title: Acid-Suppressive Therapy and Risk of Infections: Pros and Cons.
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.
authors.affiliation: Frankston Hospital, Peninsula Health, Melbourne, Australia. leonfisher@optusnet.com.au.
authors.forename: Leon
authors.identifier: http://orcid.org/0000-0002-3860-4606
authors.initials: L
authors.lastname: Fisher
authors.affiliation: The Canberra Hospital, ACT Health, Canberra, Australia.|Australian National University Medical School, Canberra, Australia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Fisher
mesh_terms: D000368:Aged; D003015:Clostridium Infections / Q000453:epidemiology; D003967:Diarrhea / Q000139:chemically induced; D004347:Drug Interactions; D006635:Histamine H2 Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007239:Infections / Q000453:epidemiology* / Q000209:etiology; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D012306:Risk
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors