Heartburn drugs overused in hospital patients not at risk for stress ulcers.

Acid-reflux drugs like Nexium and Zantac, which suppress stomach acid, are among the most widely prescribed in the country. Their use has been steadily increasing among hospital patients, often for indications that have no supporting scientific evidence. Between 40% and 70% now receive some version of these acid-suppressive drugs, also known as proton pump inhibitors (PPIs), during a hospital stay. A new study, published last month in the Journal of the American Medical Association, found that they have a higher incidence of pneumonia than hospital patients not given these drugs.

The study was led by Shoshana J. Herzig, MD and colleagues who analyzed the medical records of all patients who where admitted to a large, urban, academic medical center in Boston from 2004 through 2007. To be included in this study, the patients had to be at least 18 years of age and hospitalized for three or more days, but not admitted to the intensive care unit. The study included nearly 64,000 patients, 52% of whom were given one of two classes of acid-suppressive drugs--PPI (e.g., Nexium, Prevacid, Prilosec) and [histamine.sub.2] receptor antagonist (e.g., Pepcid, Zantac).

In-Hospital Pneumonia Doubled

Of the hospital patients who received the acid-suppressive drugs, 4.9% developed pneumonia while in the hospital, compared with 2% of the people not given the drugs. PPIs were more likely than [H.sub.2] receptor antagonists to be prescribed and to cause an increase in pneumonia. After taking into account that the drug-treated people may have been sicker at the time of hospital admission, the researchers estimated that the people given acid-reflux drugs had a 30% increase in their risk of pneumonia compared with those not given the drugs.

Although hospital patients frequently are given acid-reflux drugs for preventive purposes, Dr. Herzig and colleagues say that the drugs are approved by the FDA only for people at high risk for developing stress ulcers.

This study builds on the results of earlier acid-reflux drug studies that found people on these medicines have a higher incidence of hip fracture, community-acquired pneumonia (i.e., pneumonia that occurred outside of a hospital), and diarrhea associated with Clostridium difficile.

Maryann Napoli, Center for Medical Consumers [C] 2009

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