Forgacs and Loganayagam mention the increasing risk of Clostridium difficile infection with use of proton pump inhibitors (PPIs) in hospitals.1 The ability of the vegetative form of C difficile to survive in gastric contents with a raised pH caused by excess use of PPI has been proposed as a potential mechanism.2 It is therefore important that PPIs are used as intelligently as the antimicrobials in every hospital. The editorial mentions several reports of the misuse of PPIs. In addition, Grube and May found that as many as 71% of patients in general medicine wards received some sort of acid suppression without an appropriate indication.3
In another study of 357 patients who received stress ulcer prophylaxis during their stay in the intensive care unit, 80% continued on gastric acid suppressants on transfer from the unit, with the treatment being inappropriate in 60%, 25% of them being discharged with inappropriate prescription of gastric acid suppressants.4 The problem is not unique to hospital practice and family doctors have also been shown to contribute.5
A hospital “antacid policy” would be helpful, in which the judicious use of gastric acid suppressant treatment (not limited to PPIs) is advised. Consideration could also be given to withholding them while patients receive broad spectrum antibiotics. Audits and research should be conducted to identify the length of time the PPIs should be prescribed for an adequate effect. Patients should be advised of lifestyle measures , which have been well established to help in many situations of excessive acid production.
Competing interests: None declared.
References
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