PPIs: The Dark Side

Two new studies add two more infections to the list of those that are associated with the use of proton pump inhibitors (PPIs). Previous papers have shown that ventilator-associated pneumonia, community-acquired pneumnonia, and Clostridium difficile associated disease are associated with PPI use. The large cohort study in today's JAMA found that PPIs were associated with a significant increase in the rate of hospital-acquired pneumonia in non-ICU, non-ventilated patients. And this month's American Journal of Gastroenterology contains a study showing that PPIs are associated with a higher rate of spontaneous bacterial peritonitis in patients with cirrhosis. Given the mounting evidence of risk for infection, coupled with the high frequency of use in hospitalized patients (the JAMA paper found that 52% of inpatients were prescribed PPIs), hospitals should probably begin to restrict the use of these agents.