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July 1, 2009

Proton Pump Inhibitors and the Risk for Clostridium difficile Infection—Reply

JAMA. 2009;302(1):31-32. doi:10.1001/jama.2009.902

In Reply: Dr Famularo and colleagues raise an interesting and relevant point regarding acid antisecretory therapy as a potential risk factor for CDI. Because the patient under discussion was not reported to be on treatment with a PPI or histamine2-receptor antagonist, this topic was excluded from the review.

In several epidemiologic studies, the use of PPIs has been associated with CDI.13 However, a causal relationship has not been established, and many potential confounding variables exist. Proton pump inhibitors are certainly overprescribed. In my institution, for example, PPI use was recorded in 25% of hospital inpatients with CDI in 1998 compared with 74% in 2005 (P < .001).4 For inpatients, an initial appropriate PPI prescription for prophylaxis against gastrointestinal bleeding is often transformed into a prolonged treatment course with no clear indication. Transient dyspepsia or occasional heartburn are inadequate but common indications for ongoing PPI therapy.

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