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Acid-reducing medications increase risk for C. difficile infection in children
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Prescription acid-reducing medications are associated with a significantly increased risk for Clostridium difficile infection in infants and children, according to new research data.
“There’s no question that acid-reducing medications alleviate heartburn in adults, but there’s little evidence of benefit in healthy infants and younger children,” Daniel E. Freedberg, MD, MS, assistant professor of medicine at Columbia University Medical Center, said in a press release. “Given our findings about the risk involved, pediatricians may hesitate before prescribing these drugs unless there is evidence of acid-related disease.”
Aiming to assess the relationship between proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs) and C. difficile infection, Freedberg and colleagues performed a population-based, case-control study nested within a large outpatient dataset (The Health Improvement Network) using data from 1995-2014. They recruited 650 pediatric patients with C. difficile infection and 3,200 matched controls, and the primary exposure was defined as H2RA or PPI prescription issued at least 8 days before index and used within 90 days of index.
They determined that the adjusted odds ratio for C. difficile infection and acid-reducing medication was 7.66 (95% CI, 3.24-18.1), and that acid-reducing medication was associated with C. difficile infection in infants aged less than 1 year (OR = 5.24; 95% CI, 1.13-24.4) and in children aged 1 to 17 years (OR = 9.33; 95% CI, 3.25-26.8). The risk for C. difficile infection was significantly higher with PPIs compared with H2RAs, and also with recent exposure compared with distant exposure (both P trend < .01).
The researchers concluded that acid suppression medication is associated with increased risk for C. difficile infection in children in outpatient settings. Like antibiotics, the researchers wrote “acid suppression medication may increase risk for [C. difficile infection] by causing alterations in the gastrointestinal microbiome.”
“The microbiome in children is highly mutable up until age four or five,” Freedberg said in the press release. “It is unknown whether changes during that formative period, due to antibiotics or PPIs, could alter the microbiome’s ultimate trajectory.” – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.
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