Clostridium difficile-associated diarrhea following the therapy with antibiotic and proton pump inhibitors in a 77-year-old man with several comorbidities

Abstract

Rationale: Clostridium difficile -associated diarrhea (CDAD) remains a persistent challenge, with substantially increased incidence and severity. The rising burden of CDAD requires urgent identification of preventable risk factors. Patients concerns: A 77-year-old man with the symptoms of abdominal pain and watery diarrhea was readmitted to the hospital, who received cephalosporins and proton pump inhibitors (PPIs) during the initial hospitalization for 12 days until discharge. Antibiotic-associated diarrhea was seriously suspected. And the stool sample was immediately sent for inspection for C difficile . He had a history of chronic bronchitis, coronary heart disease, and osteonecrosis. Diagnosis: CDAD, renal insufficiency Interventions: Oral vancomycin was administered for 14 days. Outcomes: On the third day after readmission, the stool sample turned out to be positive for both C difficile toxin and its antigen. After 10-day treatment with vancomycin, diarrhea symptoms disappeared and his stools became normal. Lessons: In elderly patients with multiple comorbidities, PPIs must be administered cautiously to minimize the risk for adverse effects including CDAD. It is important to identify the preventable risk factors of CDAD for clinicians and pharmacists. Oral vancomycin therapy seems to be effective in CDAD.

Proton pump inhibitor use does not increase dementia and Alzheimer’s disease risk: An updated meta-analysis of published studies involving 642305 patients

“…Moreover, PPIs are currently over-the-counter medications in many countries; therefore, their use is often not monitored by a healthcare specialist. Notable, side effects of long-term use of PPIs are gaining increasing attention, especially cognitive impairment [5–9]. Wijarnpreecha et al[10] performed pooling analyses regarding the association of dementia and PPI users, and indicated an increased risk of dementia and Alzheimer’s disease (AD) among PPI users.…”

Proton pump inhibitor use increases hepatic encephalopathy risk: A systematic review and meta-analysis

“…Accumulating data illustrate the potential risks associated with long-term PPI therapy, including pneumonia, spontaneous bacterial peritonitis, gastric cancer, vitamin B12 deficiency, Clostridium difficile -associated diarrhea, myocardial infarction, hypomagnesemia, chronic kidney disease, and hip fracture[5-10]. Regarding concerns over liver adverse effects, a previous meta-analysis showed that PPIs increase the risk of hepatic encephalopathy (HE) in patients with hepatic failure[11].…”

Should we routinely prescribe proton pump inhibitors peri-operatively in elderly patients with hip fractures? A review of the literature

“… 30 , 31 This risk is further increased to a greater extent by concurrent use of broad-spectrum antibiotics, especially cephalosporins, fluoroquinolones, clindamycin and some penicillins. 31 , 32 , 33 There is an associated increased risk of both community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) in patients exposed to PPIs. 9 , 13 , 34 The identification of preventable risk factors and careful patient selection is essential in prevention of these complications.…”