PPI Use May Increase Risk of Community-Acquired Pneumonia

Increased incidence of CAP was noted in stroke patients using PPIs.

The use of proton pump inhibitors (PPIs) was associated with an increased risk of community-acquired pneumonia (CAP), particularly in patients with stroke or in those who received these agents for less than 30 days, according to the findings of a meta-analysis recently published in Annals of Pharmacotherapy.

As there is a lack of evidence defining the relationship between PPI use and the risk of CAP, the study authors aimed to evaluate this association in an effort to reduce potential PPI-related adverse events and ensure medication safety in patients. PubMed, The Cochrane Library, and Web of Science databases were searched for eligible studies published between January 1, 2004, and February 1, 2021. The incidence of CAP was the primary outcome of the analysis.

The study authors identified and included 13 eligible studies with a total of 2,098,804 patients. “Our study revealed that the incidence of CAP was higher in PPI users than non-PPI users ([odds ratio (OR)], 1.37 (95% CI, 1.22-1.53)], especially for PPI duration less than 30 days (OR, 1.49 [95% CI, 1.34-1.66]),” they reported.

Findings of the analysis also revealed PPI use significantly increased the risk of CAP within the stroke disease population compared with non-PPI use (OR, 1.52; 95% CI, 1.33-1.75). The authors additionally noted that this association was not observed in patients with liver disease (OR, 1.13; 95% CI, 0.98-1.30).

“In view of the above conclusions, clinicians and clinical pharmacists should carefully consider their decision of PPI prescription and weigh the pros and cons before use of the medication, especially in patients with low risk of stress ulcer or [gastrointestinal bleeding], so as to reduce PPI use and the incidence of CAP caused by PPI abuse,” the study authors concluded.


Xun X, Yin Q, Fu Y, He X, Dong Z. Proton pump inhibitors and the risk of community-acquired pneumonia: An updated meta-analysis. Annals of Pharmacotherapy. Published online August 2021. doi: 10.1177/10600280211039240