Clostridium difficile infection – is use of proton pump inhibitors a risk factor?

  • Clostridium difficile infection (CDI) is associated with considerable morbidity and risk of mortality.
  • Risk factors for CDI include antibiotic use, hospitalisation, advanced age, underlying morbidity and inflammatory bowel disease.
  • Three systematic reviews/meta-analyses using data from observational case-control and cohort studies conclude that whilst a causal link has not been established, the weight of evidence suggests an association between use of proton pump inhibitors (PPIs) and CDI.
  • Public Health England guidelines recommend that consideration be given to stopping or reviewing the need for PPIs in patients with or at high risk of CDI.

This Medicines Q&A has not been updated since 2016 but is currently being updated (due Spring 2021)

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