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Association of Clostridium difficile infections with acid suppression medications in children

Cade M Nylund1, Matilda Eide1, Gregory H Gorman1

  • 1Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.

The Journal of Pediatrics
|August 13, 2014
PubMed

Insights

Acid suppression medications like PPIs and H2RAs increase the risk of Clostridium difficile infections (CDIs) and recurrent CDIs in children. Careful consideration of their use is advised, particularly for high-risk individuals.

Area of Science:

  • Pediatric infectious diseases
  • Gastroenterology
  • Pharmacology

Background:

  • Acid suppression medications are linked to Clostridium difficile infections (CDIs) in adults.
  • The association between these medications and CDI in pediatric populations requires further investigation.

Purpose of the Study:

  • To evaluate the association between acid suppression medications and the incidence of CDI in children.
  • To assess the risk of recurrent CDI in pediatric patients using these drugs.

Main Methods:

  • A retrospective self-controlled case series design was employed.
  • Utilized TRICARE military health system database records for children aged 2-18 years (2001-2013).
  • Calculated relative incidences (RIs) of CDI and recurrent CDI comparing periods with and without proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs).

Main Results:

  • Acid suppression medications were prescribed in 48.8% of 2531 CDI cases.
  • Prescription of PPIs, H2RAs, or both was associated with a significantly increased risk of CDI.
  • Recurrent CDI was also more likely during periods of PPI and H2RA use.

Conclusions:

  • Acid suppression medications are associated with an elevated risk of both initial and recurrent Clostridium difficile infections in children.
  • Judicious prescribing of acid suppression medications is recommended, especially for pediatric patients at higher risk for CDI.
Abstract

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