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Proton pump inhibitors seem to influence biliary pathogens

May's issue of the Alimentary Pharmacology & Therapeutics examines the use of proton pump inhibitors and the spectrum and number of biliary pathogens in patients with acute cholangitis.

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Knowledge of the bacterial spectrum for acute cholangitis is essential for adequate empiric antibiotic treatment.

Dr Weber and colleagues from Germany analyzed the relation of proton pump inhibitors (PPI) with biliary pathogens in patients with acute cholangitis.

The research team performed a retrospective study of 278 patients with 318 acute cholangitis episodes using an endoscopic database.

The relationship between PPI and microbiological outcomes was assessed by logistic and poisson regression analysis for binary and count data.

In total, 882 pathogens were isolated, of which, 120 cholangitis episodes occurred with PPI.

The team observed that 198 cholangitis episodes were without PPI.

PPI use was associated with a higher incidence of oropharyngeal flora in the biliary tract
Alimentary Pharmacology & Therapeutics

The research team showed that PPI use resulted in a 23% increase in the number of biliary pathogens, whereas stent therapy, previous interventional procedures, genesis, age and sex showed no significant association with the number of biliary pathogens.

Significantly, more cholangitis episodes with more than one pathogen isolated occurred during PPI treatment.

Analysis of intrinsic anti-microbial resistance patterns was performed.

The team found that anti-microbial combination therapies were significantly more required to cover all isolated pathogens in cholangitis episodes with PPI than in cholangitis episodes without PPI.

The team noted that PPI use was associated with a significantly higher incidence of oropharyngeal flora in the biliary tract.

Dr Weber's team concludes, "Proton pump inhibitors seem to influence biliary pathogens by increasing the number and broadening the spectrum of biliary pathogens."

"However, the findings of this hypothesis-generating study need to be tested by confirmatory studies."

Aliment Pharmacol Ther 2014: 39(10): 1194–1203
09 May 2014

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