Heartburn medications that reduce stomach acidity may contribute to Clostridium difficile infections that occur outside of hospitals. So-called community-acquired infections are much less common than those found in hospitals and appear to have a different pattern according to research in the December 21, 2005 issue of the Journal of the American Medical Association.
Researchers found that patients who were taking a proton pump inhibitor such as Nexium™, Prilosec™ or Protonix™ were three times more likely to have a C.difficile infection than study participants who were not. H2–receptor antagonists including Tagamet™, Zantec™, and Pepcid™ doubled risk for C.difficile. There was also a moderate increase in risk among patients taking NSAIDs — non-steroidal anti-inflammatory drugs.
Using a United Kingdom database, the research team found 1672 cases of C. difficile among patients registered in community practices. Among them was a subset of patients with community-acquired infections. Since C.difficile is ordinarily considered a hospital-acquired infection, it was a surprise that 70% of the patients had not been hospitalized in the year prior to their infection and 50% of them had not had antibiotic treatment within the past three months. The patients with C.difficile were matched to controls in the practices without the disease.
The team concluded:
“The use of acid-suppressive therapy, particularly proton pump inhibitors, is associated with an increased risk of community-acquired C difficile. The unexpected increase in risk with non-steroidal anti-inflammatory drug use should be investigated further.”
In a news release from McGill University where the research was done, Dr. Sandra Dial said,
”We believe drugs that reduce gastric acidity provide a more hospitable environment within which C. difficile bacteria can colonize.”
Dr. Dial and the research team at McGill compared rates of community-acquired c.difficile in the United Kingdom General Practice Research Database (GPRD over ten years. In discussing the increased incidence, Dr. Dial said,
”In 1994 there was less than one C. difficile case per 100,000 people in the database, By 2004, this number had increased exponentially to 22 cases per 100,000”
Clostridium difficile, also known as C. difficile, is a bacterial microbe that can cause an infection of the bowel. The usual symptoms are diarrhea, fever and abdominal pain. Careful hand washing is key to preventing its spread.
Proton pump inhibitors include:
- Prilosec™ (omeprazole)
- Prevacid™ (lansoprazole)
- Aciphex™ (rabeprazole)
- Protonix™ (pantoprazole)
- Nexium™ (esomeprazole)
H2–receptor antagonists include:
- Tagamet™ (Cimetidine)
- Zantac™ (Ranitidine)
- Pepcid™ (Famotidine)
- Axid™ (Nizatidine)
McGill University researchers have recently sequenced the genome of the antibiotic-resistant strain of C.difficile that has caused the epidemics of hospital-based intestinal infections in the United States and Canada.
December 10, 2008 at 1:17 pm, David Olsen said:
While anectdotal, I developed a “community” C. difficile infection following a two week regimen of a non-steroidal anti-inflammatory drug (Lodine).