Study: Heartburn Drugs May Increase Patient Risk About half of all hospitalized patients are given a widely used class of drugs, which includes Prilosec and Nexium, to prevent stress ulcers. However, a recent study found that these proton pump inhibitors increase the risk of potentially deadly hospital-based pneumonia by 30 percent.
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Study: Heartburn Drugs May Increase Patient Risk

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Study: Heartburn Drugs May Increase Patient Risk

Study: Heartburn Drugs May Increase Patient Risk

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MELISSA BLOCK, host:

Another widely used class of drugs has come under suspicion. This time, it's not a painkiller or a cholesterol drug. It's a class of drugs that are prescribed for heartburn and ulcers. NPR's Joanne Silberner reports that the drugs appear to increase the risk of pneumonia in hospitalized patients.

JOANNE SILBERNER: Last year, $14 billion worth of proton pump inhibitors were prescribed in the U.S., according to health-care information company IMS Health. About half of all hospitalized patients get a drug like Nexium or Prevacid or Prilosec to suppress acid production in the stomach. Shoshana Herzig, of Beth Israel Deaconess Medical Center in Boston, wasn't sure that's such a good idea. Several studies of non-hospitalized patients suggest that the drugs increase the risk of pneumonia, possibly by dampening the immune system or allowing bacteria from the stomach to infect the lungs. So, she and several colleagues looked at the charts of 64,000 patients admitted to her hospital.

Dr. SHOSHANA HERZIG (Chief Medical Resident, Beth Israel Deaconess Medical Center, Boston): We found that patients who are exposed to these medications during their hospitalization had a higher rate of hospital-acquired pneumonia. It was a 30-percent increased odds.

SILBERNER: Another way to think of it: The drugs could cause one extra case of pneumonia among every 111 hospitalized patients who get them.

Dr. HERZIG: It sounds like a small number, but when you take into account the fact that 50 percent - some studies estimate that up to 70 percent - of hospitalized patients are exposed to these medications, it actually becomes a very large number of patients who are at risk.

SILBERNER: Herzig says the drugs have been proven to prevent ulcers only in very sick patients.

Dr. HERZIG: Patients who are not on a ventilator, who are not in intensive-care unit, are at relatively low risk for stress ulcers. So in those patients, we would hope there would be a decline in prescription of these medications.

SILBERNER: The study is very well done, says Jerry Avorn, professor of medicine at Harvard Medical School. But he says by the nature of how it was done, by looking back at records, it's not by itself conclusive.

Dr. JERRY AVORN (Professor of Medicine, Harvard Medical School): You always run the risk that the people who got acid-suppressing drugs may have been for some reason a little sicker in ways that they couldn't quite discern.

SILBERNER: Thus making patients on the drugs more likely to get pneumonia, though the researchers did some statistical adjustments to take other illnesses into account. Avorn says more studies are needed. What concerns him is that the question is just being asked now.

Dr. AVORN: It is one of the most striking examples we have had recently - that our drug surveillance system for safety problems, once a drug is widely used on the market, is somewhere between nonexistent and broken.

SILBERNER: Drug companies aren't going to check, he says. And the federal government has been slow off the mark in looking at drugs, like the painkiller Vioxx. The results of the new study appear in the current issue of the Journal of the American Medical Association. Manufacturers of several proton pump inhibitors say they'll be looking at the study. One says there's conflicting evidence on the safety issue.

Joanne Silberner, NPR News.

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