Antibiotics and acid suppression therapy in adults

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  • Proton pump inhibitors (PPIs) and H2 antagonists are associated with an increased risk of Clostridium difficile infection.
  • It is not recommended to stop these drugs when antibiotics are prescribed.
  • PPIs are an important part of managing peptic ulcer disease and preventing serious GI bleeding. Stopping PPI/H2 antagonists may cause harm.
  • On admission complete a medicine reconciliation, review the need for PPI/H2 antagonists, based on the original indication for use, and ongoing benefit.
  • 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.


    • 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.

Patients with diarrhoea on a PPI or H2 antagonist

  • Is this Clostridium difficile infection (CDI)? Send samples for microbiological testing
  • Consider other causes of diarrhoea, including medication (such as PPIs) or laxatives
  • For suspected or proven CDI follow management advice in Guidelines
  • In proven CDI: stop any use of anti-motility agents and gastric acid suppressant agents (including PPIs/H2 antagonists) if possible