- Gastric acid suppression therapy such as proton pump inhibitors (PPIs) and H2 antagonists are associated with an increased risk of C. difficile infection (CDI).
- On admission complete a medicine reconciliation, review the need for PPI/H2 antagonists, based on the original indication for use, and ongoing benefit. Consider reducing dose and stopping if safe to do so.
- Patient had been on long-term gastric acid suppression for heartburn or dyspepsia may experience re-bound symptoms when treatment is stopped abruptly. Consider using PRN (when required) antacids short term to manage the symptoms.
- Note PPIs are an important part of managing peptic ulcer disease and preventing serious GI bleeding. In these cases, stopping PPI/H2 antagonists may cause harm.
- If a patient is to be started on antibiotics:
- Start Smart: follow the empirical guidance and document an antibiotic plan. Avoid 4C antibiotics in patients over 75 years old or in patients with previous CDI.
4C ANTIBIOTICS: COAMOXICLAV, CIPROFLOXACIN, CLINDAMYCIN, CEPHALOSPORINS
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- Senior review @ 24 hours: is the diagnosis correct, are antibiotics required?
- Then Focus @ 72 hours: Review the patient + microbiology results and decide on an antibiotic outcome. Use the shortest treatment course possible.
Consider:
- Is this C.difficile infection (CDI)? Send stool samples for microbiological testing.
- Consider other causes of diarrhoea, including medication, such as laxatives and gastric suppressive therapies.
- For suspected or proven CDI follow management advice in CDI Guidelines.
- Stop any use of anti-motility agents, and if safe and possible, consider tapering down and stopping gastric acid suppressant agents (including PPIs/H2 antagonists).
Antimicrobial prescribing: NHS Lothian
