Do PPIs Raise Risk of Infection Among Children?

A cohort study based on data from the EPI-MERES Register in France revealed that exposure to proton pump inhibitors (PPIs) was associated with increased risks of serious infections among children, the researchers reported in JAMA Pediatrics.

The authors noted that it has been established that PPIs can alter the microbiota or have a direct impact on the immune system of patients. “However, only a few studies were conducted in children, with conflicting results,” they wrote, which led them to conduct this study of PPI use and serious infection overall and by infection site and pathogen.

“We included all children born between January 1, 2010, and December 31, 2018, who received a treatment for gastroesophageal reflux disease or other gastric acid–related disorders, namely PPIs, histamine 2 receptor antagonists, or antacids/alginate,” they wrote. Children were followed until admission to the hospital for serious infection, loss to follow-up, death, or December 31, 2019.

The study population comprised 1,262,424 children, including 606,645 who received PPI therapy and 655,779 who did not. “PPI exposure was associated with an increased risk of serious infections overall (aHR, 1.34; 95% CI, 1.32-1.36). Increased risks were also observed for infections in the digestive tract (aHR, 1.52; 95% CI, 1.48-1.55); ear, nose, and throat sphere (aHR, 1.47; 95% CI, 1.41-1.52); lower respiratory tract (aHR, 1.22; 95% CI, 1.19-1.25); kidneys or urinary tract (aHR, 1.20; 95% CI, 1.15-1.25); and nervous system (aHR, 1.31; 95% CI, 1.11-1.54) and for both bacterial (aHR, 1.56; 95% CI, 1.50-1.63) and viral infections (aHR, 1.30; 95% CI, 1.28-1.33),” the investigators wrote.

They concluded that proton pump inhibitors should not be used without a clear indication in the pediatric population due to the increased risk of serious infections.

Reference:

Lassalle M, Zureik M, Dray-Spira R. Proton pump inhibitor use and risk of serious infections in young children. JAMA Pediatr. Published online August 14, 2023. doi:10.1001/jamapediatrics.2023.2900