Thomas Fekete, MD
Is concurrent prescription of proton pump inhibitors (PPIs) and antibiotics for incident Clostridium difficile infection (CDI) associated with an increased risk for recurrent CDI?
Linkage of administrative and pharmacy databases from the New England Veterans Healthcare System.
New England, USA.
1166 inpatients and outpatients (median age 74 y, 97% men) who had a first positive finding of C. difficile during a specified period, ≥ 1 year of prior Veterans Affairs health care system use, and treatment with metronidazole or oral vancomycin within 3 days before or after the index CDI.
Prescription of any oral PPI ≤ 14 days after incident CDI diagnosis; for outpatients, the end date of the most recent antecedent prescription was extended by 10% to account for possible missed doses.
Positive finding for C. difficile toxin 15 to 90 days after diagnosis of the incident CDI.
527 patients (45%) were exposed to PPIs ≤ 14 days after incident CDI diagnosis; most were prescribed omeprazole, 20 mg/d, or an equivalent dose of another PPI. 251 patients (22%) had recurrent CDI. PPI prescription was associated with an increased risk for recurrent CDI (Table).
Concurrent prescription for proton pump inhibitors and antibiotics for incident Clostridium difficile infection was associated with an increased risk for recurrent C. difficile infection.
Association between recurrent C. difficile infection (CDI) and prescription for proton pump inhibitors (PPIs) ≤ 14 days after incident CDI treated with antibiotics *
*Abbreviations defined in Glossary. RRI, NNH, and CI calculated from hazard ratio and control event rate in article. Analysis adjusted for age, incident CDI treatment, additional antibiotics, length of hospital exposure, ischemic heart disease, esophageal disease, rheumatologic disease, peptic ulcer disease, pulmonary disease, and systemic corticosteroid use.
Fekete T. Concurrent PPIs and antibiotics for incident C. difficile infection were associated with increased risk for recurrent infection. Ann Intern Med. ;153:JC4–12. doi: 10.7326/0003-4819-153-8-201010190-02012
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Published: Ann Intern Med. 2010;153(8):JC4-12.
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