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Resistance to antibiotics due to gastric acid suppressants?


Gastric acid-suppressive agents such as proton pump inhibitors (PPIs), histamine 2(H2) antagonists or antacids effectively reduce gastro-oesophageal and gastro-duodenal symptoms and prevent the development of ulcers due to NSAIDs. There is, however, abundant scientific literature showing that prolonged use of gastric acid suppressants is not without its risks. For instance, PPIs are associated with intestinal infections and diarrhoea caused by Clostridioides difficile, vitamin B12 and magnesium deficiencies, as well as interstitial nephritis. In addition, attempts to discontinue this medication often fail due to rebound effects. A recently published meta-analysis adds another risk to this list: intestinal colonisation by antibiotic-resistant bacteria. In view of the growing worldwide problems of resistance, this emphasizes the importance of carefully considering whether to start or end treatment with gastric acid suppressants.

  • A meta-analysis of observational studies found that the use of gastric acid-suppressive agents, particularly proton pump inhibitors, is associated with an increased risk of intestinal colonisation by  highly resistant micro-organisms. 
  • The presence of resistant bacteria in the intestines increases the risk of infections by these bacteria at other sites in the body, and turns the patient into a source of infection for others.
  • An increased risk of infecting others also increases the risk of antibiotic resistance spreading through the population.
  • Assessing the options for gradually discontinuing the use of gastric acid suppressants may help reduce unnecessary prolonged use of these drugs.

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Authors

  • Sander van den Bogert, dr, pharmacist