NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

C diff infections and PPIs

There was an increase in Clostridium difficile infection (CDI) rates within NHSGGC in quarter 3 last year. A review of cases highlighted that almost half of the patients with CDI were prescribed a proton pump inhibitor (PPI). PPI use is a potential risk factor for CDI.


Key Points

  • If CDI is suspected, The Therapeutics Handbook recommends stopping or rationalising gastric acid suppression where possible
  • As with all medicines, the risks versus the benefits of PPI use should be considered when prescribing.
  • Local guidance is available on the recommended durations for all acceptable indications for PPIs. Restrict treatment to the recommended durations as much as possible
  • Dose reduction or as required use should be considered as appropriate.
  • When initiating a PPI, it is good  practice to document the reason and the expected duration of treatment. This aids prescribing review.


Health Protection Scotland (HPS) guidelines state that PPIs are a major risk factor for CDI and recommend that they are stopped where possible in patients with suspected CDI. The link is that gastric juice is more bactericidal at low pH. The host therefore becomes more susceptible to bacterial infections as gastric pH increases with acid suppression.


A Medicines Update Extra bulletin on PPIs published in December 2015 discussed the limited evidence.  A Scottish cohort study published in 2017 suggests that community prescribing of acid-suppression medicines increases the risk of CDI.  In addition, a recent meta-analysis of observational studies showed that the use of gastric acid suppressants was also associated with a significantly increased risk of recurrent CDI. 



Published 25/04/2017