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Use of Acid Suppression Medication is Associated With Risk for C. difficile Infection in Infants and Children: A
Daniel E Freedberg1, Esi S Lamousé-Smith2, Jenifer R Lightdale3
1Division of Digestive and Liver Diseases.
Insights
Acid suppression medications, including proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs), significantly increase the risk of Clostridium difficile infection (CDI) in children. This association was observed in both infants and older children, highlighting the need for careful consideration of these drugs.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Pharmacology
Background:
- Acid suppression medications are increasingly prescribed to children.
- A known association exists between these medications and Clostridium difficile infection (CDI) in adults.
Purpose of the Study:
- To evaluate the relationship between acid suppression medication use and the incidence of CDI in pediatric patients.
- To determine if the risk of CDI differs between proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) in children.
Main Methods:
- A population-based, nested case-control study design was employed.
- Pediatric patients aged 0-17 years were included, with exclusions for comorbidities associated with CDI.
- Patients with CDI codes were matched 1:5 with controls based on age, sex, and other demographic factors. Exposure was defined as PPI or H2RA use within 8-90 days.
Main Results:
- The study identified 650 CDI cases and 3200 controls.
- Acid suppression medication use was associated with a significantly increased odds ratio (OR) for CDI (7.66).
- The risk was elevated in both infants (<1 year, OR 5.24) and older children (1-17 years, OR 9.33), with higher risk observed for PPIs and recent medication exposure.
Conclusions:
- Acid suppression medications are associated with an increased risk of CDI in pediatric outpatients.
- The timing of medication exposure and the type of drug (PPIs vs. H2RAs) influence the risk.
- Clinicians should carefully consider the potential for increased CDI risk when prescribing acid suppression medications to children.
Background:
Acid suppression medication is associated with Clostridium difficile infection (CDI) in adults and is increasingly prescribed to children. This study evaluated the relationship between acid suppression medication and incident CDI in children.
Methods:
This was a population-based, nested case-control study. Patients were eligible if they were aged 0-17 years with 3 or more visits or 1 year or more of follow-up in the dataset. Patients were excluded if they had comorbidities that associate with CDI and might also associate with acid suppression medication. Patients with codes for CDI were matched 1:5 with control patients by age, sex, medical practice, time of entry into the dataset, and follow-up time. The primary exposure was use of acid suppression medication with proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs) within 8-90 days.
Results:
We identified 650 CDI cases and 3200 controls. The adjusted odds ratio (OR) for CDI and acid suppression medication was 7.66 (95% confidence interval [CI], 3.24-18.1). Acid suppression medication was associated with CDI in infants aged <1 year (OR, 5.24; 95% CI, 1.13-24.4) and children aged 1-17 years (OR, 9.33; 95% CI, 3.25-26.8). There was increased risk for CDI with PPIs compared with H2RAs and with recent compared with distant exposure.
Conclusions:
Acid suppression medication associated with CDI in infants and children in the outpatient setting, with an effect based on medication timing. Increased risk for CDI should be factored into the decision to use acid suppression medication in children.
