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QJM Advance Access originally published online on April 14, 2008
QJM 2008 101(6):445-448; doi:10.1093/qjmed/hcn035
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© The Author 2008. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Overuse and inappropriate prescribing of proton pump inhibitors in patients with Clostridium difficile-associated disease

M.N. Choudhry1, H. Soran2 and H.M. Ziglam

From the 1Department of Musculoskeletal Medicine and 2Manchester Royal Infirmary, Platt Rehab II, Purple zone, Manchester, M13 9WL, UK

Address correspondence to Dr Hisham Ziglam, Manchester Royal Infirmary, Department of Medicine, Manchester, M13 9WL, UK. email: hisham.ziglam{at}gmail.com

Received 11 November 2007 and in revised form 29 January 2008


  Abstract

Background: Clostridium difficile is the most common infectious cause of colitis and has been increasingly diagnosed in hospitalized patients. The number of prescriptions for proton pump inhibitors (PPIs) has also increased significantly over time. Few studies have reported an association between C. difficile-associated disease (CDAD) and PPI use.

Aim: To assess the extent and appropriateness of PPI prescribing in patients diagnosed with C. difficile infection.

Methods: We prospectively studied PPI prescriptions in 138 hospitalized patients diagnosed with C. difficile infection over a 4-month period. Clostridium difficile infections were diagnosed by the presence of C. difficile toxin in the stools. The appropriateness of prescriptions and relevant investigations were assessed by interview of patients and review of patient records.

Results: Sixty-four percent (88 of 138) of all patients who developed C. difficile infections were on PPIs. A valid indication for PPIs therapy was not apparent in 63% of the patients.

Conclusion: There appears to be a widespread and inappropriate use of PPIs in hospital practice. Reduction of unnecessary PPIs use may be an additional strategy to reduce the incidence of this infection.


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