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Comment & Response |

Treatment for Clostridium difficile Infection in Adults—Reply

Krishna Rao, MD1; Natasha Bagdasarian, MD, MPH2; Preeti N. Malani, MD, MSJ1,3
[+] Author Affiliations
1Department of Internal Medicine, University of Michigan Health System, Ann Arbor
2Department of Internal Medicine, Wayne State University, Detroit, Michigan
3Associate Editor, JAMA
JAMA. 2015;313(19):1976. doi:10.1001/jama.2015.3674.
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In Reply We agree with Drs McDonald and Lee that PPI use has been associated with incident and recurrent C difficile infection. Even though we mentioned this association in the text, tables, and figures of our review, we chose not to include PPI or other modifiable risk factors (other than concurrent use of non–C difficile infection antibiotics), in the treatment algorithm. There are numerous reports highlighting an association with acquisition and recurrence of C difficile infection; however, to date, no one has prospectively studied whether discontinuation of PPI therapy improves outcomes from C difficile infection. Despite this, we believe discontinuation of PPI therapy is a reasonable consideration, particularly because many patients receive it unnecessarily.1

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May 19, 2015
Emily G. McDonald, MD; Todd C. Lee, MD, MPH
1Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
JAMA. 2015;313(19):1974-1975. doi:10.1001/jama.2015.3668.
May 19, 2015
Cong Dai, MD, PhD; Min Jiang, MD, PhD; Ming-Jun Sun, MD, PhD
1Department of Gastroenterology, First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, China
JAMA. 2015;313(19):1975-1976. doi:10.1001/jama.2015.3671.
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