Avoid Routine Proton Pump Inhibitor Therapy for Prophylaxis in Hospitalized Patients
Preface: A retrospective study at a Boston hospital examined the effect of routine proton pump inhibitor therapy in hospitalized stroke patients. No clear benefit was seen and multivariate analysis concluded that there was an increased risk of nosocomial pneumonia from this therapy.
Results of study:
Among 1676 patients admitted with stroke (and hospitalized for at least 2 days) during a 10-year period, 80% received acid-suppressive therapy (usually PPIs). The incidence of hospital-acquired pneumonia was 17%. In multivariate analysis with adjustment for 30 potential confounders (including mechanical ventilation), PPI use was associated with significantly higher risk for pneumonia (odds ratio, 2.7); a smaller elevated risk with H2RA use (OR, 1.6) was not significant.
Growing evidence has shown that proton pump inhibitors are overused both in the ambulatory care setting and in hospitals and lead to an increased risk of community-acquired pneumonia, Clostridium difficile infection, and nosocomial pneumonia. Outside of critically ill patients on the ventilator, there is no role for routine acid suppressive therapy for “prophylaxis” in the hospital.
Herzig SJ et al. Acid-suppressive medication use in acute stroke and hospital-acquired pneumonia. Ann Neurol 2014 Nov; 76:712.