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Acid-suppressive Medications And Infections: Pro And Contra | 58042
Journal of Gastrointestinal & Digestive System
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This review summarizes the benefits, risks and appropriate use of acid-suppressing drugs (ASDs), proton pump inhibitors
(PPIs) and histamine-2 receptor antagonists (H2RAs), particularly in the elderly, advocating a rationale balanced and
individualized approach aimed to minimize any serious adverse consequences. It focuses on current controversies on the
potential of ASDs to contribute to infections - bacterial, parasitic, fungal, protozoan and viral, comprehensively and critically
discusses the growing body of observational literature linking ASD use to a variety of enteric, respiratory, skin and systemic
infectious diseases and complications (Clostridium difficile diarrhoea, pneumonia, spontaneous bacterial peritonitis,
septicaemia and other). The pathogenic mechanisms of ASD-associated infections (related and unrelated to the inhibition of
gastric acid secretion, alterations of the gut microbiome and immunity), agent-specific side effects and drug-drug interactions
are also described. However, accumulating data on the complexity of ASD effects involving important defense systems and
resulting in dysbiosis and increased risk for infections, particularly in the elderly, should not invalidate their use as long as it
is evidence based. Both probiotics use and correcting vitamin D status may have a significant protective effect decreasing the
incidence of ASD- associated infections. The importance of individualized therapy and caution in ASD use considering the
possible spectrum of adverse events, the balance of benefits and potential harms, factors that may predispose to and actions
that may prevent/attenuate adverse effects is evident. A six step practical algorithm for ASD therapy based on the best available
evidence is recommended.
Alexander Fisher, MBBS, PhD, Doc Med. Sci, FRACP, is a Senior Consultant, Department of Geriatric Medicine, Australian National University Medical School and The Canberra Hospital.