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Don't abuse sessional GPs

GP prescribing of proton pump inhibitors is fuelling the surge in rates of Clostridium difficile infection, a new study of UK patients concludes.

The research also warned that C. difficile was no longer mainly a problem for hospitals, with three-quarters of cases now community acquired.

The study came after Pulse revealed exclusively in July that Government advisers were warning use of PPIs could be driving up C. difficile rates.

The study of around 17,000 cases of C. difficile from the UK general practice research database found proton pump inhibitors and antibiotics both increased risk three-fold.

The researchers also found a significant 30 per cent increase in risk with use of NSAIDs, although they said this could be the result of residual confounding.

Study leader Professor Samy Suissa, professor of epidemiology at McGill University, Montreal, Canada, said there should be much greater focus on community-acquired cases. 'This is something I think should be under the microscope of the GP ­ they should be looking at this when diagnosing.'

He added: 'Patients who are taking these drugs should be monitored.'

The study ­ presented to the GPRD annual conference in London last week ­ found community-acquired cases of C. difficile increased exponentially between 1994 and 2004, from less than 0.1 per 100,000 to 20 per 100,000.

Dr Richard Cunningham, consultant medical microbiologist at Derriford Hospital in Plymouth, said: 'Not everyone needs the maximum dose of the most powerful PPIs. If a lower dose of a less potent one can control symptoms, that's what should be used.'

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