Respiratory infection proton pump inhibitors

Gastric acid is an important barrier to colonization and infection of the stomach and intestine from ingested bacteria. Increases in gastric bacterial concentrations are detected in patients taking proton pump inhibitors, which is of unknown clinical significance. Some studies have reported an increased risk of both community-acquired respiratory infections and nosocomial pneumonia among patients taking proton pump inhibitors. 

Esomeprazole is the 5-isomer of omeprazole. The pharmacology, pharmacokinetics, efficacy, and safety of esomeprazole have been reviewed (1). Esomeprazole produces acid control comparable to that of currently available proton pump inhibitors. It undergoes less hepatic metabolism than omeprazole, has an oral availability of 89% at a dose of 40 mg, and a half-life of 1.5 hours. Esomeprazole is well tolerated its common adverse effects are diarrhea, headache, nausea, abdominal pain, respiratory infection, and sinusitis. 

Systematic reviews Laboratory and chnical evidence suggest that the increase in gastric pH caused by proton pump inhibitors may be linked to increased bacterial colonization of the stomach and may predispose patients to an increased risk of respiratory infections. The association of proton pump inhibitors (esomeprazole, rabeprazole, pantoprazole, and omeprazole) with respiratory infections has been studied in a systematic review of seven studies, four of which showed a trend towards an association, although most of the studies failed to show a significant correlation [54 ]. 

Sultan N, Nazareno J, Gregor J. Association between proton pump inhibitors and respiratory infections a systematic review and meta-analysis of chnical trials. Can J Gastroenterol 2008 22 761-6. 

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