Pantoprazole, a proton pump inhibitor (PPI), is used for stress ulcer prophylaxis (SUP). Use of PPIs has been associated with an increased risk of community-acquired pneumonia. A study by Miano et al evaluated if SUP with pantoprazole increases the risk of pneumonia compared with ranitidine in critically ill patients.

A cardiothoracic surgery database was used and patients who had received SUP with pantoprazole or ranitidine, were retrospectively identified, without crossover between agents. From January 1, 2004, to March 31, 2007, investigators identified 887 patients, with 53 patients excluded. In the analysis, the incidence of nosocomial pneumonia was compared in 377 patients who received pantoprazole and 457 patients who were given ranitidine.

Nosocomial pneumonia was noted in 9.3% of patients given pantoprazole, compared with 1.5% of patients who were administered ranitidine (odds ratio [OR], 6.6). Twenty-three covariates were used to estimate the odds of receiving pantoprazole, as measured by propensity score (C-index, 0.77). With the help of this score, pantoprazole and ranitidine patients were divided based on their probability of receiving pantoprazole. After propensity adjusted multivariable logistic regression, treatment with pantoprazole appeared to be an independent risk factor for nosocomial pneumonia (OR, 2.7).

Use of pantoprazole for SUP was tied to a greater risk of nosocomial pneumonia compared to ranitidine.

Source: Miano TA, Reichert MG, Houle TT, et al. Nosocomial pneumonia risk and stress ulcer prophylaxis: a comparison of pantoprazole vs ranitidine in cardiothoracic surgery patients. Chest. 2009 Aug;136(2):440-447.