Acid Reducing Medications May Increase Risk of Clostridium Difficile Infection Interview with:
Cade M. Nylund, MD, MS, FAAP
Major, United States Air Force, Medical Corps
Assistant Professor of Pediatrics
F. Edward Hébert School of Medicine
Uniformed Services University
Bethesda, Maryland

Medical Research: What are the main findings of the study?

Dr. Nylund: The main findings of our study were that among children who were identified as having a diagnosis of Clostridium difficile infection (CDI), CDI was about twice as likely to occur during periods when the child was taking either a proton pump inhibitor or histamine-2 receptor antagonist.

In brief, we performed a type of observational study called a self-controlled case series. Our data source was the military health system database which contains billing records for patients seen in military and civilian facilities. We identified all cases of Clostridium difficile infections in children ages 2-18 over the period of October 2001 to July 2013. We also identified periods when children were prescribed both proton pump inhibitors and histamine-2 receptor antagonists over the same time period. We compared the incidence of CDI during periods prescribed acid suppression medications to periods not prescribed these medications.

Medical Research: Were any of the findings unexpected?

Dr. Nylund: The association of Clostridium difficile infection with acid suppression medications is well established in adults and our identified risk in children was expected. However, we were surprised by the rapidly increasing rate of Clostridium difficile infection in children. The rate of recurrent Clostridium difficile infection was rapidly increasing and appeared to be an exponential trend increasing from 5 cases per year in 2002 to 61 per year in 2012.

Medical Research: What should clinicians and patients take away from your report?

Dr. Nylund:  That both proton pump inhibitors and Histamine-2 receptor blockers are not benign medications and risks are involved.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Nylund: Further studies are necessary to identify combined effects of other medications including combined effects of antibiotics and acid suppression medications. We recommend that any future clinical trial of acid suppression medication in children include monitoring for Clostridium difficile infection.


Association of Clostridium difficile Infections with Acid Suppression Medications in Children.

Nylund CM1, Eide M2, Gorman GH2.
J Pediatr. 2014 Aug 8. pii: S0022-3476(14)00614-3. doi: 10.1016/j.jpeds.2014.06.062. [Epub ahead of print]


Last Updated on September 3, 2014 by Marie Benz MD FAAD