Proton pump inhibitors and 180-day mortality in the elderly after Clostridium difficile treatment

Our study was conducted to determine whether use of gastric acid-suppressive agents increased the risk of Clostridium difficile-associated disease (CDAD) in a medical intensive care unit of one of the first hospitals to be threatened by the current CDAD epidemic in Quebec, Canada. Our findings suggest that efforts to determine risk factors for CDAD should focus on other areas, such as older age and antibiotic use.

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Anaphylaxis To Pantoprazole: A Case Report And Prerequisite For Vigilant Prescribing Practises For Proton Pump Inhibitors

Current Drug Safety ◽

10.2174/1574886316666210728115356 ◽

2021 ◽

Vol 16 ◽

Author(s):

Jerin James ◽

Jamuna Rani ◽

Sathyanarayanan V ◽

Syed Hussain Fayaz ◽

Althab Begum

Keyword(s):

Proton Pump Inhibitors ◽

Proton Pump ◽

The Elderly ◽

Acid Synthesis ◽

Synthesis Inhibitor ◽

Case Summary ◽

The World ◽

Prescribing Practice ◽

Physician Awareness ◽

Gastrointestinal Complaints

Background: Pantoprazole is a Proton Pump Inhibitor, commonly used by clinicians all over the world as gastric acid synthesis inhibitor for a wide variety of gastrointestinal disorders and the efficacy and the safety of the drug is unsurmountable. PPIs are being prescribed nowadays for unapproved indications as well and it is one among the widely used medications in the world. Consequently, adverse events are commonly reported nowadays with proton pump inhibitors and it is essential to improve the physician awareness regarding judicious prescribing practice. Objective: To report a case of anaphylaxis to pantoprazole which occurred in a patient admitted with gastrointestinal complaints. Case summary: Within few minutes of intravenous infusion of pantoprazole, a 75-year-old female developed anaphylaxis. The adverse drug reaction was promptly diagnosed, and patient was resuscitated. Conclusion: It is imperative that clinicians should be aware of this adverse effect that might occur with pantoprazole and hence be more cautious while prescribing the drug, especially in the elderly.

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Implementation of Global Strategies to Prevent Hospital-Onset Clostridium difficile Infection: Targeting Proton Pump Inhibitors and Probiotics

Annals of Pharmacotherapy ◽

10.1177/1060028017694050 ◽

2017 ◽

Vol 51 (10) ◽

pp. 848-854 ◽

Cited By ~ 7

Author(s):

Paul O. Lewis ◽

Timothy S. Lundberg ◽

Jennifer L. Tharp ◽

Clay W. Runnels

Keyword(s):

Cohort Study ◽

Clostridium Difficile ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Clostridium Difficile Infection ◽

Retrospective Cohort ◽

Significant Risk ◽

Significant Risk Factor ◽

Order Sets ◽

Global Strategies

Background: Proton pump inhibitors (PPIs) have been identified as a significant risk factor for the development of Clostridium difficile infection (CDI). Probiotics given concurrently with antibiotics have been shown to have a moderate impact on preventing CDI. Objective: To evaluate the effectiveness of hospital-wide interventions designed to reduce PPI use and increase probiotics and whether these interventions were associated with a change in the incidence of hospital onset (HO)-CDI. Methods: This retrospective cohort study compared 2 fiscal years: July 2013 to June 2014 (FY14) and July 2014 to June 2015 (FY15). In July of FY15, global educational initiatives were launched targeting PPIs. Additionally, a HO-CDI prevention bundle was added to antibiotic-containing order sets targeting probiotics. Overall PPI use, probiotic use, and incidence of HO-CDI were recorded and compared for each cohort. Charts were also reviewed for patients who developed HO-CDI for the presence and appropriateness of a PPI and presence of probiotics. Results: The interventions resulted in a decrease in PPI use by 14% or 96 doses/1000 patient days (TPD; P = 0.0002) and a reduction in IV PPI use by 31% or 71 doses/TPD ( P = 0.0008). Probiotic use increased by 130% or 126 doses/TPD ( P = 0.0006). The incidence of HO-CDI decreased by 20% or 0.1 cases/TPD ( P = 0.04). Conclusions: A collaborative, multifaceted educational initiative directed at highlighting the risks associated with PPI use was effective in reducing PPI prescribing. The implementation of a probiotic bundle added to antibiotic order sets was effective in increasing probiotic use. These interventions were associated with a decrease in incidence of HO-CDI.

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“Top ten”: another alert on the prescription of proton-pump inhibitors (PPIs) for the elderly

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.65.6.742 ◽

2019 ◽

Vol 65 (6) ◽

pp. 742-743

Author(s):

Maria Elisa Gonzalez Manso ◽

Henrique Souza Barros de Oliveira

Keyword(s):

Proton Pump Inhibitors ◽

Proton Pump ◽

The Elderly

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Profile of patients admitted in a pulmonology ward and developing Clostridium difficile enterocolitis

Pneumologia ◽

10.2478/pneum-2019-0010 ◽

2019 ◽

Vol 68 (1) ◽

pp. 31-36

Author(s):

Ioana Cojocaru ◽

Livia Luculescu ◽

Daniela Negoescu ◽

Irina Strâmbu

Keyword(s):

Clostridium Difficile ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Respiratory Infections ◽

Demographic Data ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Male Predominance ◽

Number Of Patients ◽

Lower Intestine

Abstract Clostridium difficile is an anaerobic bacterium than can colonise the lower intestine and cause enterocolitis in susceptible patients. Clostridium difficile infection (CDI) is typically a nosocomial infection, favoured by treatment with antibiotics (especially with broad-spectrum drugs), proton pump inhibitors, but also comorbidities, old age and prolonged hospitalisation. Based on the observation that in the past years, the frequency of nosocomial CDI has increased in the Institute of Pulmonology, Bucharest, this retrospective observational study aimed to analyse the characteristics of admitted patients who develop CDI, in order to identify possible particular features and risk factors. Accordingly, medical files from 80 patients admitted from January 2015 to August 2017 were analysed for demographic data, respiratory diagnosis, comorbidities, blood tests, treatments prescribed, time of CDI onset, evolution and outcome. The number of patients studied was 29 in 2015, 16 in 2016 and 35 in 2017, with slight male predominance. Totally, 54 patients (67.5%) had tuberculosis (pulmonary or pleural), 12 had lung cancer, five had respiratory infections, two had chronic obstructive pulmonary disease and seven had other diseases. All patients but nine were receiving antibiotics: tuberculosis drugs, cephalosporins, fluoroquinolones and beta-lactams. About half of the patients received proton pump inhibitors. Most patients had several comorbidities. Mean time since admittance to onset of diarrhoea was 20 days. CDI was treated with metronidazole or vancomycin. The evolution was favourable in 90% of patients, but eight patients (10%) died This study highlights a high frequency of CDI in patients treated for tuberculosis. Due to insufficient data, no epidemiological consideration could be made. Further studies are needed to assess the relationship among tuberculosis, tuberculosis treatment and CDI.

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