Simultaneous taking of antacids and antibiotics increases risk of multidrug-resistant bacterial infection

A study has shown that the simultaneous use of gastric acid suppressants—which treat gastritis, gastroesophageal reflux disease, and peptic ulcers—and antibiotics increase the risk of carbapenem-resistant enterobacteria infections by activating the transmission of antibiotic resistance in the intestinal microbiome (an ecosystem composed of various microbial species).

The National Institute of Infectious Diseases (NIID) said Wednesday that the “Microbiome Longitudinal Study for Decolonization of Intestinal Multidrug-resistant Enterobacteria,” a part of the hospital-based human microbiome research and development project, has confirmed it after analyzing a longitudinal study of intestinal multidrug-resistant bacteria in critically ill patients.

Carbapenem-resistant enterobacteria infections, multidrug-resistant bacterial infections with limited treatment options, and high mortality rates in bacteremia are reported to be urgent antibiotic-resistant threats worldwide.

impact of the gut microbiome on carbapenem-resistant enterobacteria infections is being studied globally but remains under-researched. In addition, while the risks of non-antibiotic gastric acid suppressants are known, the mechanisms through the gut microbiome have been insufficient.

The researchers analyzed the clinical data of 282 patients with and without carbapenem-resistant H. pylori after admission to the intensive care unit. They confirmed that concomitant use of antibiotics and acid suppressants increased the risk of carbapenem-resistant H. pylori infection.

In 98 of these patients for whom fecal samples were available, gut microbiome analysis showed that concomitant prescription of antibiotics and acid suppressants was associated with changes in the microbiome and increased transmission of antibiotic resistance genes among a wider range of bacteria compared to no antibiotics.

"Caution should be taken when prescribing antibiotics and gastric acid suppressants, especially proton pump inhibitors, at the same time,” researchers said. “Since the overuse of gastric acid suppressants may affect the intestinal microbiome and cause adverse effects, including carbapenem-resistant enterobacteria infections, it is necessary to develop strategies for the appropriate use of antibiotics and gastric acid suppressants and to verify their effectiveness."