Overuse of acid-suppressive therapy in hospitalized patients1

Nardino, Robert J.; Vender, Ronald J.; Herbert, Peter N.

doi:10.1111/j.1572-0241.2000.03259.x

Cited by 112 publications

(52 citation statements)

References 19 publications

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“…10, 25, 26 The most widely cited guidelines on stress ulcer prophylaxis do not include acute stroke as a risk factor for gastrointestinal bleeding in and of itself, and recommend stress ulcer prophylaxis with acid-suppressive medication only in hospitalized patients admitted to the ICU with either coagulopathy or mechanical ventilation. 27 While we are unable to assess coagulopathy in this study as laboratory values were not available, 57% of patients spent time in the ICU, and only 29% of patients in our study received mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

Acid‐suppressive medication use in acute stroke and hospital‐acquired pneumonia

Herzig

Doughty

Lahoti

et al. 2014

Annals of Neurology

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Objective Pneumonia is a morbid complication of stroke, but evidence-based strategies for its prevention are lacking. Acid-suppressive medications have been associated with increased risk for nosocomial pneumonia in hospitalized patients. It is unclear whether these results can be extrapolated to stroke patients, where other factors strongly modulate pneumonia risk. We investigated the association between acid-suppressive medication and hospital-acquired pneumonia in patients with acute stroke. Methods All patients hospitalized with acute ischemic stroke or intracerebral hemorrhage in a large, urban academic medical center in Boston, Massachusetts from 6/2000 – 6/2010, ≥ 18 years of age and hospitalized for ≥ 2 days were eligible for inclusion. Acid-suppressive medication use was defined as any pharmacy charge for a proton-pump inhibitor or histamine-2 receptor antagonist. Multivariable logistic regression was used to control for confounders. The main outcome measure was hospital-acquired pneumonia, defined via ICD-9-CM codes. Results The cohort comprised 1,676 admissions. Acid-suppressive medication was ordered in 1,340 (80%) and hospital-acquired pneumonia occurred in 289 (17.2%). The unadjusted incidence of hospital-acquired pneumonia was higher in the group exposed to acid-suppressive medication compared to unexposed (20.7% versus 3.6%, OR=7.0, 95% CI 3.9–12.7). After adjustment, the OR of hospital-acquired pneumonia in the exposed group was 2.3 (95% CI 1.2–4.6). The association was significant for proton-pump inhibitors (OR=2.7, 95% CI 1.4–5.4), but not for histamine-2 receptor antagonists (OR=1.6, 95% CI 0.8–3.4). Interpretation In this large hospital-based cohort of patients presenting with acute stroke, acid-suppressive medication use was associated with increased odds of hospital-acquired pneumonia.

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Section: Discussionmentioning

confidence: 99%

Acid‐suppressive medication use in acute stroke and hospital‐acquired pneumonia

Herzig

Doughty

Lahoti

et al. 2014

Annals of Neurology

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“…Following the widespread use of acid-suppressive agents [1-3], which are the mainstream of treatment in peptic ulcer disease and acid reflux associated esophageal disease, its eliminating acid barrier effect had been implied the association with infectious disease. Proton pump inhibitor (PPI) had marketed for more than two decades, and several studies had mentioned its direct link to several enteric infections, such as Clostridium diffcile colitis, Salmonella enteritis [4,5] and spontaneous bacterial peritonitis in patients with advanced cirrhosis [6].…”

Section: Introductionmentioning

confidence: 99%

Acid suppressive agents and risk of Mycobacterium Tuberculosis: case–control study

et al. 2014

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BackgroundThe acid-suppressive agents have been linked with an increased risk of infectious disease. The relationship between these drugs and Mycobacterium Tuberculosis (TB) was not been reported.MethodsWe conducted a case–control study using data from National Health Insurance research database of Taiwan. From 1996 till 2008, and 6541 cases were defined as TB infection/activation (ICD-9 coding plus prescription two of four first-line anti-TB regimen for at least one month). Control subjects who were matched to the TB cases by age and sex were selected with 10:1 ratio. Medical records including acid-suppressive agent prescription and comorbidity, and socioeconomic status were analyzed.ResultsTB infection/activation was more frequent to comorbidity with chronic diseases, alcohol abuse, malignancy, immune deficient/suppression status and acid-related disease (peptic ulcer, reflux esophagitis). Among the TB cases, there was higher exposure record to acid-suppressive agents within 3 months before TB index date (OR 2.43(2.06-2.88) and 1.90 (1.68-2.14) for proton pump inhibitor (PPI) and histamine 2 receptor antagonist (H2RA) respectively). After adjusting confounding factors, PPIs prescription 3 months before TB index date had an association of TB infection/activation (adjusted OR 1.63(1.61-1.63)). Similar result was found in H2RA user (adjusted OR 1.51(1.50-1.52)). The association of acid-suppressive agents in TB infection/activation was fade gradually when the drug prescription period extended.ConclusionsRecent prescription of acid-suppressive agent seems to associate the TB infection/activation. In the society where TB was prevalent, evaluation of pulmonary TB before prescription of PPI or H2RA is warranted.

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“…1,2 Initiation of PPIs in hospitalized patients should therefore be limited to specific clinical situations, such as upper gastrointestinal bleeding or stress ulcer prophylaxis in the critically ill. 3 Prior studies suggest significant overuse of PPIs in hospitalized patients exists, 4–7 but these were published before the widespread implementation of local and national quality improvement efforts targeted at reducing PPI use in medical inpatients (e.g. Society of Hospital Medicine’s (SHM) “Choosing Wisely” list 8 ).…”

Section: Introductionmentioning

confidence: 99%