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Researchers found that antibiotics and other commonly prescribed medications substantially increase the risk of Clostridioides difficile infection, and their analysis shows that more drugs impact the gut microbiome than previously believed, as published in Gut. Recent antibiotic exposure (within 30 days) carried the highest risk. Some agents (eg, nitroimidazoles and intestinal anti-infectives) had particularly high odds ratios (OR), likely reflecting treatment-related bias, the authors say.
- Lincosamides (adjusted OR 31.4, 95% confidence interval [CI] 27.9-35.3)
- Combinations of penicillins (aOR 19.8, 95% CI 15.9-24.5)
- Antidiarrheals (aOR 7.3, 95% CI 6.8-7.8)
- Analgesics (aOR 2.8, 95% CI 2.7-3.0)
- Corticosteroids (aOR 2.4, 95% CI 2.3-2.5)
- Proton pump inhibitors (aOR 1.8, 95% CI 1.7-1.8)
- Histamine H2-receptor antagonists (aOR 1.4, 95% CI 1.2-1.8)
Lipid-lowering agents (aOR 0.8, 95% CI 0.8–0.8) and aspirin (aOR 0.8, 95% CI 0.7–0.8) were associated with some decreased risk. This Swedish population-based study included 42,921 cases matched with 355,159 population controls.
What to consider: Overall, the findings reinforce the need for antibiotic stewardship and suggest clinicians should also consider C. diff risk when prescribing these medications. Authors say the study confirms previous research indicating proton pump inhibitors are an important risk factor for C. diff, especially because of the drugs’ high volume of prescriptions overall.