Pediatrics Xagena

Acid suppression medications associated with an increased risk of Clostridium difficile infections in children

Multiple studies have confirmed associations between acid suppression medication and Clostridium difficile infections ( CDIs ) in adults. Therefore, researchers sought to evaluate an association between acid suppression medications and CDI in children.

A retrospective self-controlled case series was performed utilizing billing records from the TRICARE Management Activity military health system database.
Children ages 2-18 years from October 1, 2001 to July 31, 2013, who had an outpatient or inpatient record of CDI diagnosis were included.

The relative incidences ( RIs ) of Clostridium difficile infections or recurrent CDI were calculated comparing time periods prescribed and not prescribed proton pump inhibitors ( PPIs ) or histamine-2 receptor antagonists ( H2RAs ).

There were 2531 cases of Clostridium difficile infections among 2437 patients, and 1190 ( 48.8% ) were prescribed acid suppression medications.

Clostridium difficile infections were more likely to occur during periods when patients were prescribed a PPI ( RI=2.36; 95% CI 2.22-2.52 ), H2RA ( RI=1.95; 95% CI 1.63-2.34 ), or during periods while prescribed both simultaneously ( RI=2.40; 95% CI 1.90-3.04 ).

There were 265 ( 10.4% ) cases that were classified as recurrent among 217 ( 8.9% ) patients.

Recurrent Clostridium difficile infections also was found to be more likely during prescription periods of proton pump inhibitor ( RI=1.74; 95% CI 1.51-2.00 ) and histamine-2 receptor antagonist ( RI=2.63; 95% CI 1.89-3.66 ).

In conclusion, acid suppression medications are associated with an increased risk of Clostridium difficile infections and recurrent CDI. Judicious use of acid suppression medication should be considered, especially among those at highest risk for Clostridium difficile infections. ( Xagena )

Nylund CM et al, J Pediatr 2014; 165: 979–984.e1