Acid-reducing meds up risk of C diff infection in kids: Study

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Infants and children who are given prescription acid-reducing medications face a substantially higher risk of developing Clostridium difficile infection, according to a study published recently in the online edition of Clinical Infectious Diseases.

Infants and children who are given prescription acid-reducing medications face a substantially higher risk of developing Clostridium difficile infection, according to a study published recently in the online edition of Clinical Infectious Diseases.

Related:Heartburn drugs linked to heart attacks

The findings, by Columbia University Medical Center (CUMC) researchers, suggest that pediatricians may do more harm than good by prescribing these drugs for children who have non-specific gastrointestinal symptoms such as occasional vomiting.

Lead author Daniel E. Freedberg, MD, MS, assistant professor of medicine at CUMC, and colleagues, wanted to examine whether use of proton-pump inhibitors (PPIs) and another type of common acid-reducing medication-histamine-2 receptor antagonists (H2RAs)-might be contributing to the increased incidence of C diff infection in children who have no known risk factors.

The researchers examined the health records of children in The Health Improvement Network, a database of electronic medical records maintained by general practitioners throughout the United Kingdom, using data collected from 1995 to 2014. (Children with chronic conditions that might be associated with C diff infection were excluded.) The study identified 650 outpatients who had been diagnosed with C diff infection. Each patient’s recent use of PPIs/H2RAs was compared with that of 5 age- and sex-matched controls who did not have C diff infection.

Related:PPIs linked to risk of acute kidney injury in elderly

“Use of acid suppression medications-proton pump inhibitors and histamine-2 receptor antagonists-was associated with increased risk for C difficile infection in a cohort of relatively healthy, ambulatory children,” said Dr Freedberg. “This was true for both infants and for older children.”

The study found that 2.6% (17 of 650) of the children diagnosed with C diff infection had used PPIs/H2RAs within 90 days, compared with just 0.3% (8 of 3,200) of the controls. Use of acid-reducing drugs resulted in a 7-fold increase in risk for infection with C diff. The effect was stronger for PPIs, which are more powerful than H2RAs.

“Community-acquired C diff infection is becoming more common in children who lack obvious risk factors for C diff [i.e., in children who lack serious comorbidities and have no history of antibiotic exposure)],” Dr Freedberg added.

The rate of C diff, infection in children is increasing, with a 10-fold rise from 1991 to 2009. For unknown reasons, the infection has recently emerged as a problem in relatively healthy children lacking traditional risk factors.

Studies have shown that PPIs may contribute to C diff infection in adults.

“Increased risk for C diff infection should factor into the decision of whether to use acid suppression medication in children,” Dr Freedberg said.

Read next:7 proven elements of a successful antibiotic stewardship program

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