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To the Editor: Acid suppression therapy is associated with an increased risk of community-acquired pneumonia, and Dr Herzig and colleagues¹ reported that these drugs also increase the odds of HAP by 30%. Unlike community-acquired pneumonia, this association was only apparent with proton-pump inhibitors, although it was acknowledged that the study might have been underpowered to detect a smaller effect with histamine₂ receptor antagonists. Two mechanisms were suggested for the increase in pneumonia: gastric overgrowth and aspiration of bacteria, and impaired leukocyte function.

However, these mechanisms are not mutually exclusive, and data would seem to support both as an explanation for the greater susceptibility to pneumonia observed with proton-pump inhibitors. Killing of bacteria within the stomach is largely determined by the acidity of secretions, and bacterial proliferation and overgrowth occurs when gastric pH level exceeds 4.² Proton-pump inhibitors are more effective than histamine₂ receptor antagonists at alkalinizing the stomach and are . . . [Full Text of this Article]

Matt P. Wise, DPhil
mattwise@doctors.org.uk

Anton G. Saayman, EDIC; Paul J. Frost, FJFICM
Department of Adult Critical Care
University Hospital of Wales
Cardiff, United Kingdom

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