Acid-suppressive therapy and tuberculosis

The use of proton pump inhibitors (PPIs)—including esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole—or H2 receptor antagonists (H2RAs)—such as cimetidine, famotidine, and ranitidine—has been associated with an increased risk of tuberculosis (TB). PPI use, whether alone or in combination with an H2RA, was linked to a higher TB risk than H2RA use alone.

TB cases typically occurred shortly after the initiation of antacid therapy and at low cumulative doses, suggesting that the increased TB risk may not be due to gastric acid suppression. This temporal relationship should prompt clinicians to consider TB in symptomatic patients currently or recently treated with PPIs or H2RAs, particularly in TB-endemic regions.

Source: Hong, K.J., Wang, T.C. and Tsui, K., 2025. Association of acid-suppressive therapy and tuberculosis: A causal or coincidental link to the infection?. Respiratory Investigation, 63(1), pp.27-32.