My patient with recent Clostridium difficile infection (CDI) needs a gastric acid-suppressant. Are histamine2-receptor antagonists (H2RAs) associated with CDI?

Although proton pump inhibitors (PPIs) have received much attention for their link with CDI, H2RAs have also been associated with CDI.  In a study of CDI among hospitalized patients, H2RA was associated with CDI (O.R. 1.53, 95% CI, 1.12-2.10); for daily PPI use the O.R. was 1.74 (95% CI, 1.39-2.18)1.  

A meta-analysis in 2013 reported an overall O.R. of 1.44 (95% CI 1.22-1.7) for CDI in patients treated with H2RAs2.  The estimated number needed to harm with H2RAs at 14 days after hospital admission was 58 for patients on antibiotics vs 425 for those not receiving antibiotics2.

Potential mechanism for H2RA-associated CDI is unclear, but survival of acid-sensitive vegetative forms of C. difficile in the stomach and their enhanced growth in the presence of bile salts related to gastro-esophageal reflux disease have been postulated2.

In brief, gastric acid suppression with H2RAs may increase the risk of CDI in hospitalized patients. 

 

References

  1. Howell MD Novack V, Grgurich P, et al. Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection. Arch Intern Med 2010; 170:784-790.
  2. Tleyjeh IM, Bin Abdulhak AA, Riaz M, et al. The association between histamine 2 receptor antagonist use and Clostridium difficile infection: a systematic review and meta-analysis. PLoS ONE 2013; 8:e56498.
My patient with recent Clostridium difficile infection (CDI) needs a gastric acid-suppressant. Are histamine2-receptor antagonists (H2RAs) associated with CDI?

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