Review article: Acid suppressant therapy and risk of COVID-19 infection - to use, to alter or not to use?

Abstract

Recently there have been many concerns regarding the use of acid suppression therapy in the setting of the COVID-19 pandemic. We review here the biological plausibility, the evidence and the recommendations for acid suppressant use in the present COVID-19 pandemic. After adjusting for confounding factors, PPI use, especially twice-daily dosing, seem to be associated with acquiring COVID-19 infection and worse outcomes among patients with COVID-19, compared to non-users. PPI induced hypochlorhydria may be responsible for the observed effects. Famotidine seems to protect against clinical deterioration among hospitalised and improves patient-reported outcomes among non-hospitalised patients with COVID-19, compared to non-users. Famotidine interfering maturation of SARS-CoV-2 and reducing inflammation may be responsible for the observed effect. The knowledge from the recent studies could help by reminding PPI users to be especially vigilant about following protective health behaviours and should also encourage physicians to prescribe PPIs rationally during and after the pandemic.