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Copyright © 2007. American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/04/0602-1242$06.00
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Association of proton-pump inhibitors with outcomes in Clostridium difficile colitis
RICHARD M. CADLE, PHARMD., BCPS, is Pharmacy Residency Program Director and Infectious Disease Clinical Pharmacy Specialist, Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, Assistant Professor of Medicine, Section of Infectious Diseases, Baylor College of Medicine (BCM), Houston; and Adjunct Clinical Assistant Professor, University of Texas—Austin and University of Houston Schools of Pharmacy. MOHAMMAD D. MANSOURI, B.S., is Instructor, Department of Physical Medicine and Rehabilitation, MEDVAMC and BCM. NANCY LOGAN, M.A., is Research Associate, Section of Infectious Diseases, MEDVAMC. DENISE R. KUDVA, PHARMD., is Clinical Pharmacy Specialist, Pharmacy Service, M. D. Anderson Hospital, Houston; at the time of this study she was Pharmacy Practice Resident, MEDVAMC. DANIEL M. MUSHER, M.D., is Professor of Medicine, Section of Infectious Diseases, MEDVAMC.
Address correspondence to Dr. Cadle at Pharmacy Service (119), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030 (cadle.richardmark{at}med.va.gov).
Methods. The records of inpatients at a large Veterans Affairs medical center in whom C. difficile colitis was diagnosed between June 2004 and July 2005 were retrospectively reviewed. Data collected included patient characteristics at baseline, antibiotic therapy prescribed before and during therapy for C. difficile colitis, concurrent treatment with a PPI, response to therapy for C. difficile colitis, and recurrence of the disease in the 90 days after symptoms resolved. Outcomes of therapy were classified as cures, treatment failures, or disease recurrences.
Results. A total of 140 patients (138 men and 2 women) were included in the study. Ninety-seven (69%) of patients received a PPI and 43 (31%) did not. Of patients receiving a PPI, 37 (38%) were cured of C. difficile colitis, 20 (21%) did not respond to therapy, and 40 (41%) had disease recurrence. Among the non-PPI patients, 27 (63%) were cured, 9 (21%) did not respond, and 7 (16%) had recurrence. Patients receiving PPIs were 4.17 times as likely to have recurrence as their counterparts who did not.
Conclusion. PPI therapy was associated with an increased risk of recurrent C. difficile colitis.
Index terms: Antiinfective agents; Clostridium infections; Combined therapy; Enterocolitis; Gastrointestinal drugs; Toxicity
Purpose. The role of concurrent use of proton-pump inhibitors (PPIs) in the outcomes of treatment for Clostridium difficile colitis was studied.
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