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    Monday, September 7, 2009


    Increased risks of C.dificile infection, pneumonia, bone fractures.

    Though initially "recommended for intensive-care patients to prevent stress ulcers," some 40 to 70 percent of inpatients now receive acid-suppressive drugs" like Nexium [esomeprazole], Prilosec [omeprazole], and Prevacid [lansoprazole], "with about half receiving them for the first time." This increased their risk of contracting pneumonia by 30 percent.

    We now know that PPIs also increase the chances of getting C.difficile disease, especially those patients receiving PPIs in the hospital or long term care facility..

    Gulmez et al writing in the Arch Intern Med. 2007;167(9):950-955 --Use of Proton Pump Inhibitors and the Risk of Community-Acquired Pneumonia --A Population-Based Case-Control Study conclude that the use of PPIs, especially when recently begun, is associated with an increased risk of community-acquired pneumonia. The authors conducted a population-based case-control study using data of all patients with a first-discharge diagnosis of community-acquired pneumonia from a hospital during 2000 through 2004. The adjusted odds ratio (OR) associating current use of PPIs with community-acquired pneumonia was 1.5 (95% confidence interval [CI], 1.3-1.7). N

    It is of interest that no association was found with the older histamine2-receptor antagonists like Tagamet, Pepcid and others. (OR, 1.10; 95% CI, 0.8-1.3) or with past use of PPIs (OR, 1.2; 95% CI, 0.9-1.6). Only recent initiation of treatment with PPIs (0-7 days before index date) showed a particularly strong association with community-acquired pneumonia (OR, 5.0; 95% 2.1-11.7), while the risk decreased with treatment that was started a long time ago.

    Harvard researchers are also saying that "patients who take proton pump inhibitors (PPIs) are at higher risk for pneumonia than those who do not," a finding that is of note, considering that a "growing number of hospital patients are routinely given drugs to prevent acid reflux."

    In a Harvard study all patients included in the study were hospitalized for at least three days, and none were in intensive care units." Slightly "over half -- 52 percent -- received some sort of acid-suppressing medication to help prevent stress ulcers."

    Another large retrospective study reported on 6/4/09 has found a strong link between use of proton pump inhibitors (PPIs) and hip fracture risk Those at highest risk were those patients who had at least one other standard risk factor for hip fracture, such as renal impairment, diabetes, or glucocorticoid, estrogen, and bisphosphonates use An analysis of a healthcare company's massive database found that the rate of hip fractures was increased by about 30% in patients using PPIs for two years or more prior to fracture.

    The study focused on 33,752 Kaiser members who had suffered a hip or femur fracture along with more than 130,000 controls matched for age, sex, race, and length of Kaiser membership.

    In men, the odds ratio for hip fracture with at least two years' PPI use was 1.34 (95% CI 1.18 to 1.51). The odds ratio for women was 1.28 (95% CI 1.17 to 1.39).
    The analysis showed no associations with drugs such as ACE inhibitors, calcium channel blockers, or non-narcotic painkillers.

    When the researchers looked at the effects of age, they found the greatest increase in risk among those 50 to 59 years old (OR 2.31, 95% CI 1.67 to 3.18).
    Another database study published last year indicated that PPI use for at least seven years led to a nearly doubled risk of osteoporotic fracture
    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    Deepen your understanding of "medical malpractice"...

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