Proton pump inhibitors (PPIs) are some of the most commonly prescribed medications. During the 2015-2016 financial year, over 6.7 million esomeprazole prescriptions were dispensed on the Pharmaceutical Benefits Scheme (PBS). Although PPIs are considered safe and effective, they may rarely be associated with serious adverse effects such as community-acquired pneumonia, acute interstitial nephritis, dementia, and gastroenteritis.

A recent prospective study of over 38,000 participants examined the association between PPI use and gastroenteritis. Patients currently taking a PPI were found to be 1.4 times more likely to be hospitalised for infectious gastroenteritis than patients not taking a PPI. This appears to be a dose-dependent relationship as 1.6 times greater risk was observed for patients taking more than one defined daily dose per day. The risk was not significantly different for individual PPIs.

The mechanism for this adverse effect is not entirely understood. However, it is thought that colonisation and proliferation of pathogens as a result of the suppression of gastric acid production may be a factor. Interestingly, the less potent histamine H2-receptor antagonists were not associated with an increased risk.

Previous studies have found that only 37% of PPI prescriptions satisfy the PBS approval criteria. It is, therefore, recommended that all PPI prescriptions are regularly reviewed to ensure the dose and continuation of therapy are clinically appropriate. It may also be prudent to consider alternative therapies for patients with additional risk factors for infectious gastroenteritis.

References:

  1. Chen Y, Liu B, Du W, Banks E, Kirk M. Use of proton pump inhibitors and the risk of hospitalization for infectious gastroenteritis. PLOS One. 2016; 11(12): e0168618.
  2. Forgacs I. Overprescribing proton pump inhibitors. BMJ. 2008; 336(7634): 2-3.
  3. Pharmaceutical Benefits Scheme. Expenditure and Prescriptions Twelve Months to 30 June 2016. Canberra: Australian Government Department of Health; 2016.

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