A study published in the British Journal of Clinical Pharmacology has found that taking acid-suppressing medications increases the risk for bacterial gastroenteritis in the community and in hospital-based settings. The population-based, propensity-score matched cohort study was conducted at the University College London.
The study identified 188,323 patients from a community in Scotland who took these drugs between 1999 and 2013. Those results were compared with 376,646 matched controls from the same community who did not take the prescribed medications. The medications in question include proton pump inhibitors (PPIs) and H2 receptor antagonists (H2RA).
The study’s authors reported positive test results for Clostridium difficile, Campylobacter, Salmonella, and E. coli O157 in the exposed group. Patients in the exposed group also showed increased risks of C. difficile and Campylobacter. Patients who took PPIs or H2RAs were more than twice as likely to have culture-positive diarrhea compared to those who did not take those meds.
Dr. Thomas MacDonald of the Medicines Monitoring Unit, University of Dundee, Ninewells Hospital and Medical School, U.K. said in a statement, “Users of these medications should be particularly vigilant about food hygiene as the removal of stomach acid makes them more easily infected with agents such as Campylobacter, which is commonly found on poultry.” Patients should follow safe handling instructions, avoid cross-contamination, wash their hands well with soap and water after handling raw poultry, and make sure that all poultry products are cooked to 165°F as measured with a food thermometer.
The risk of these medications in C. difficile infections is that the acid-resistant spore can convert to the vegetative form and survive in the stomach. The study also found that while gastric acid may not kill C. difficile, but it could change the growth of other bowel flora. If competing bacteria are killed, it could make it easier for pathogenic bacteria to survive.
The researchers found a clear dose response relationship between the meds and culture results. The study’s findings suggest that community-prescribed acid suppression medications are associated with increased rates of positive stool samples for C. difficile and Campylobacter. That suggests that acid-suppresions therapy is not relatively free from adverse effects.