Acid Suppression Therapy and Clostridium Difficile
Use of gastric acid suppressant drugs is now well known to increase he risk of Clostrdium difficile infection. Evidence suggests that a dose response relationship exists, with the risk of C.difficile infections rising as the level of acid suppression increases. When prescribing PPIs ensure that:
- there is a clear indication
- Lowest effective dose is used
- Therapy is reviewed regularly and reduced/stopped when appropriate
- Consider using H2 antagonists as they produce less acid suppression
Stress Ulcer Prophylaxis
- Consider acid suppression therapy for primary prevention of upper gastrointestinal bleeding in acutely ill patients in high dependency areas
- Review the need for stress ulcer prophylaxis daily to minimise duration of treatment
- Acid suppression should be discontinued when enteral feeding is established or the patients recovers
- Clearly annotate prescription 'for stress ulcer prophylaxis' so it is clear that is should be reviewed regularly
- Ranitidine is the first choice for stress ulcer prophylaxis. PPI should only be used where there is a clear infection
Procedure Specific Guidance
The following table provides information for specific procedures
Procedure | Acid suppressant of choice when NBM (IV) | Acid suppressant of choice once able to take oral (PO) | Continued on discharge |
Perforated ulcer oversew | Omeprazole 40mg OD | Omeprazole 40mg OD | 4 weeks of therapy then review |
Lap fundoplication | None required. If admitted on PPI stop post op |
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Total gastrectomy | None required. If admitted on PPI stop post op |
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Partial gastrectomy | None required. If admitted on PPI stop post op |
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Cholecystectomy | None required. If admitted on PPI review |