Warning over PPI scrips after link to C difficile

GPs should be more cautious in their prescribing of proton pump inhibitors (PPIs) because the treatment could more than triple the risk of Clostridium difficile infection, experts have said.

This followed analysis of the General Practice Research Database that identified 317 patients treated with oral vancomycin were indicative of infection with community-acquired C difficile.  

Comparison with 3,167 control patients showed that those who had been prescribed PPIs in the 90 days prior to the C difficile infection index date were three-and-a-half times more likely to develop infection than those who had not taken the drugs.  

Antibiotic use in the 90 days before clostridium infection was associated with an eight-fold increased risk of C difficile infection. Renal failure, inflammatory bowel disease and cancer, and a previous diagnosis of MRSA infection were also linked to community-acquired C difficile.  

Dr Richard Cunningham, a microbiologist from Derriford Hospital in Plymouth, Devon, said: ‘GPs should be sure that patients have a clinical indication for PPIs before prescribing them.  

‘It is widely accepted that PPIs are effective with few side-effects, but that they are sometimes prescribed generously.’  

In guidance issued in July 2004, NICE estimated that prescribing of PPIs according to its guidance could reduce use of PPIs by at least 15 per cent.  

C difficile specialist Dr Jon Brazier, from the Public Health Laboratory at the University of Wales in Cardiff, explained that higher doses of PPIs increased stomach pH, thereby allowing ingested C difficile spores to colonise the small intestine.  

‘That may upset the gut flora and so allow C difficile to grow,’ he said. 

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

Sign outside BMA House

GP suicide sparks calls for measures to protect doctors from spiraling workloads

The government and policymakers must do more to safeguard doctors and NHS staff from...

Talking General Practice logo

Podcast: Living with long COVID

In August we’re bringing you some of the best interviews from series one of the podcast....

NHS sign outside a building

Surrey GP took her own life after her job 'became overwhelming'

A Surrey GP, described as a 'dedicated, passionate and much loved' doctor, has taken...

Jeremy Hunt

Hunt tells Tory leadership hopefuls to halt pension tax charges on doctors now

Former health and social care secretary Jeremy Hunt has called for an immediate suspension...

GP in consulting room

GPs forced to prescribe antidepressants to young people denied mental health support

GPs are being forced to prescribe antidepressants to children and young people who...

Smartphone

Babylon accounts cast doubt on future of GP at Hand

NHS GP services for more than 100,000 patients registered with the controversial...