Clinical Twisters: GERD therapy and pneumonia

A 65-year-old man, D.G., who weighs 100 kg and smokes half a pack of cigarettes per day has been admitted to your hospital with pneumonia. His medical history is significant for gastroesophageal reflux disease (GERD) treated with pantoprazole (Protonix, Wyeth) 40 mg q.d. for several years. D.G. was treated empirically with ceftriaxone 1 gm q 24 h, and H. influenzae was cultured. His dismissal orders are cefaclor 500 mg t.i.d., dietitian referral, and smoking-cessation class. D.G.'s physician asks your opinion on continuing his proton pump inhibitor (PPI) to treat GERD given the newly documented risk of pneumonia (JAMA 2004;292:1955-1960).