PPI use poses risk of serious infections in kids

Use of proton pump inhibitor (PPI) appears to contribute to an increased risk of serious infections in children, as reported in a study.

The study was based on data from the Mother-Child EPI-MERES Register built from the French Health Data System. A total of 1,262,424 children who received a treatment for gastroesophageal reflux disease or other gastric acid–related disorders, such as PPIs, histamine 2 receptor antagonists, or antacids/alginate. The index date was defined as the first date that any of these medications was dispensed.

Of the children, 606,645 received PPIs (median age at index date 88 days, 53.4 percent men) and 655,779 did not receive a PPI (median age 82 days, 52.2 percent men). Children who received PPIs were more likely to present with comorbidities, including respiratory diseases, and to use corticosteroids.

Over a median follow-up of 3.8 years, a total of 152,055 children received a diagnosis of a serious infection, yielding an incidence rate of 2.99 per 100 person-years. In multivariable Cox models, PPI exposure was associated with a heightened risk of serious infections overall (adjusted hazard ratio [aHR], 1.34, 95 percent confidence interval [CI], 1.32–1.36).

In terms of infection sites, the risk increase associated with PPI use was seen for infections in the digestive tract (aHR, 1.52, 95 percent CI, 1.48–1.55); ear, nose, and throat sphere (aHR, 1.47, 95 percent CI, 1.41–1.52); lower respiratory tract (aHR, 1.22, 95 percent CI, 1.19–1.25); kidneys or urinary tract (aHR, 1.20, 95 percent CI, 1.15–1.25); and nervous system (aHR, 1.31, 95 percent CI, 1.11–1.54).

A risk increase was also noted for both bacterial (aHR, 1.56, 95 percent CI, 1.50–1.63) and viral infections (aHR, 1.30, 95 percent CI, 1.28–1.33).

The findings do not support the use of PPIs without a clear indication in children.