Acid-reducing meds up risk of C diff infection in kids: Study

Infants and children who are given prescription acid-reducing medications face a substantially higher risk of developing Clostridium difficile infection, according to a study published recently in the online edition of Clinical Infectious Diseases.

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The findings, by Columbia University Medical Center (CUMC) researchers, suggest that pediatricians may do more harm than good by prescribing these drugs for children who have non-specific gastrointestinal symptoms such as occasional vomiting.

Lead author Daniel E. Freedberg, MD, MS, assistant professor of medicine at CUMC, and colleagues, wanted to examine whether use of proton-pump inhibitors (PPIs) and another type of common acid-reducing medication-histamine-2 receptor antagonists (H2RAs)-might be contributing to the increased incidence of C diff infection in children who have no known risk factors.

The researchers examined the health records of children in The Health Improvement Network, a database of electronic medical records maintained by general practitioners throughout the United Kingdom, using data collected from 1995 to 2014. (Children with chronic conditions that might be associated with C diff infection were excluded.) The study identified 650 outpatients who had been diagnosed with C diff infection. Each patient’s recent use of PPIs/H2RAs was compared with that of 5 age- and sex-matched controls who did not have C diff infection.

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“Use of acid suppression medications-proton pump inhibitors and histamine-2 receptor antagonists-was associated with increased risk for C difficile infection in a cohort of relatively healthy, ambulatory children,” said Dr Freedberg. “This was true for both infants and for older children.”

The study found that 2.6% (17 of 650) of the children diagnosed with C diff infection had used PPIs/H2RAs within 90 days, compared with just 0.3% (8 of 3,200) of the controls. Use of acid-reducing drugs resulted in a 7-fold increase in risk for infection with C diff. The effect was stronger for PPIs, which are more powerful than H2RAs.

“Community-acquired C diff infection is becoming more common in children who lack obvious risk factors for C diff [i.e., in children who lack serious comorbidities and have no history of antibiotic exposure)],” Dr Freedberg added.

The rate of C diff, infection in children is increasing, with a 10-fold rise from 1991 to 2009. For unknown reasons, the infection has recently emerged as a problem in relatively healthy children lacking traditional risk factors.

Studies have shown that PPIs may contribute to C diff infection in adults.

“Increased risk for C diff infection should factor into the decision of whether to use acid suppression medication in children,” Dr Freedberg said.

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