Overprescribing of PPIs linked to C difficile risk

Two thirds of patients with C difficile found to be taking PPIs leading to concerns over inappropriate scrips.

C difficile
C difficile

GPs should limit their prescribing of proton pump inhibitors (PPIs) because the treatment could increase the risk of Clostridium difficile infection.

The warning comes after UK research revealed that 64 per cent of patients who developed C difficile were on PPIs, although only 38 per cent of the scrips met NICE criteria.

The study involved 138 hospitalised patients diagnosed with C difficile infection over a four-month period.

In all, 88 patients were found to be on PPIs, 75 of who had been prescribed the drugs by their GP.

Under NICE guidance, patients should be given PPIs for two to four weeks for uninvestigated dyspepsia or one to two months for gastro-oesophageal reflux disease.

But these indications were found in just 34 of the patients on PPIs. Five patients had continued to receive PPIs after clearing the infection.

The researchers from Manchester Royal Infirmary conclude that 'there appears to be widespread and inappropriate use of PPIs', and call for better adherence to NICE guidance.

Dr Jim Price, a GP in Chichester who has an interest in gastroenterology, said: 'GPs are prescribing large numbers of PPIs because they are effective drugs.

'But it is important to review patients and take them off these drugs when they are not needed.'

PPI use changes the flora in the gut, increasing susceptibility to the infection, he added.

sanjay.tanday@haymarket.com

QJM Online 2008

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