title: Proton Pump Inhibitors and Clostridium Difficile Infection: Are We Propagating an Already Rapidly Growing Healthcare Problem?
abstract: Proton pump inhibitors (PPIs) have been associated withClostridium difficileinfection (CDI) in several recent studies. The exact mechanism through which PPIs may causeClostridium difficileinfection is not well understood. One potential mechanism to explain this association may be that elevated gastric pH levels facilitate the growth of potentially pathogenic upper and lower gastrointestinal tract flora. AlthoughClostridium difficilespores are acid resistant, vegetative forms are susceptible to acidity. Higher gastric PH therefore increases vegetative bacteria counts in the small and large intestine. Other potential mechanisms include impairment of leukocytes and other immune responses and antimicrobial properties of PPIs. In recent years, much research has been contributed to prove the relationship between PPIs and CDI as causal. Most studies however, fail to prove causality due to the use of antibiotics and other medications during time of initial diagnosis of CDI. PPIs continue to also be one of the most heavily prescribed drugs in our country. As primary and recurrent infection caused byClostridium difficilecontinues to rise, more data must be collected to determine better treatment, overall management, and the role that PPIs may play in its propagation.
authors: Department of Internal Medicine, Lutheran HealthCare, 150 55th Street, Brooklyn, NY, USA.
authors: Rashmee
authors: R
authors: Patil
authors: Department of Internal Medicine, Lutheran HealthCare, 150 55th Street, Brooklyn, NY, USA.
authors: LeAnn
authors: L
authors: Blankenship
keywords: Cause-effect relationship; Clostridium difficile infection; Complications; Management; Proton pump inhibitors; Recurrence; Treatment