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Comment & Response
May 19, 2015

Treatment for Clostridium difficile Infection in Adults—Reply

Author Affiliations
  • 1Department of Internal Medicine, University of Michigan Health System, Ann Arbor
  • 2Department of Internal Medicine, Wayne State University, Detroit, Michigan
  • 3Associate Editor, JAMA
JAMA. 2015;313(19):1976. doi:10.1001/jama.2015.3674

In Reply We agree with Drs McDonald and Lee that PPI use has been associated with incident and recurrent C difficile infection. Even though we mentioned this association in the text, tables, and figures of our review, we chose not to include PPI or other modifiable risk factors (other than concurrent use of non–C difficile infection antibiotics), in the treatment algorithm. There are numerous reports highlighting an association with acquisition and recurrence of C difficile infection; however, to date, no one has prospectively studied whether discontinuation of PPI therapy improves outcomes from C difficile infection. Despite this, we believe discontinuation of PPI therapy is a reasonable consideration, particularly because many patients receive it unnecessarily.1

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