Time for a hospital antacid policy on Clostridium difficile

doi:10.1136/bmj.39458.465845.3A

BMJ 2008;336:109 (19 January), doi:10.1136/bmj.39458.465845.3A

Letters

Overprescribing PPIs

Time for a hospital antacid policy on Clostridium difficile

The first 150 words of the full text of this article appear below.

Forgacs and Loganayagam mention the increasing risk of Clostridiumdifficile infection with use of proton pump inhibitors (PPIs)in hospitals.¹ The ability of the vegetative form of C difficileto survive in gastric contents with a raised pH caused by excessuse of PPI has been proposed as a potential mechanism.² It istherefore important that PPIs are used as intelligently as theantimicrobials in every hospital. The editorial mentions severalreports of the misuse of PPIs. In addition, Grube and May foundthat as many as 71% of patients in general medicine wards receivedsome sort of acid suppression without an appropriate indication.³

In another study of 357 patients who received stress ulcer prophylaxisduring their stay in the intensive care unit, 80% continuedon gastric acid suppressants on transfer from the unit, withthe treatment being inappropriate in 60%, 25% of them beingdischarged with inappropriate prescription of . . . [Full text of this article]

Jecko Thachil, SpR

¹ Liverpool University, Liverpool

jeckothachil@yahoo.co.uk