Overuse and inappropriate prescribing of proton pump inhibitors in patients with Clostridium difficile-associated disease

QJM. 2008 Jun;101(6):445-8. doi: 10.1093/qjmed/hcn035. Epub 2008 Apr 14.


Background: Clostridium difficile is the most common infectious cause of colitis and has been increasingly diagnosed in hospitalized patients. The number of prescriptions for proton pump inhibitors (PPIs) has also increased significantly over time. Few studies have reported an association between C. difficile-associated disease (CDAD) and PPI use.

Aim: To assess the extent and appropriateness of PPI prescribing in patients diagnosed with C. difficile infection.

Methods: We prospectively studied PPI prescriptions in 138 hospitalized patients diagnosed with C. difficile infection over a 4-month period. Clostridium difficile infections were diagnosed by the presence of C. difficile toxin in the stools. The appropriateness of prescriptions and relevant investigations were assessed by interview of patients and review of patient records.

Results: Sixty-four percent (88 of 138) of all patients who developed C. difficile infections were on PPIs. A valid indication for PPIs therapy was not apparent in 63% of the patients.

Conclusion: There appears to be a widespread and inappropriate use of PPIs in hospital practice. Reduction of unnecessary PPIs use may be an additional strategy to reduce the incidence of this infection.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Ulcer Agents / therapeutic use*
  • Clostridioides difficile*
  • Drug Prescriptions / standards*
  • Enterocolitis, Pseudomembranous / drug therapy*
  • Female
  • Guideline Adherence / standards
  • Humans
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Proton Pump Inhibitors / therapeutic use*


  • Anti-Ulcer Agents
  • Proton Pump Inhibitors