Vonoprazan as safe and effective as proton pump inhibitors (PPIs) against Clostridioides difficile infection (CDI) suggests an article published in the Journal of Gastroenterology and Hepatology.

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Proton pump inhibitors are commonly used to reduce gastric acid secretion, but they have been repeatedly reported as a trigger for Clostridioides difficile infection, a leading cause of nosocomial diarrhea. However, only a few studies have reported on the association between vonoprazan, a novel potassium-competitive acid blocker, and CDI. Yohei Saruta and team evaluated the association between various classes of acid suppressants, including PPIs and vonoprazan, and CDI with special attention paid to differences in the magnitudes of association between them.

The study was conducted using a retrospective hospital-based cohort from a secondary-care hospital in Japan, consisting of 25,821 patients. The eligible CDI cases were defined as hospital-onset cases, and a multivariable adjusted logistic regression analysis for the entire cohort and propensity analyses for subgroups consisting of PPI and/or vonoprazan users at various doses were performed.
The results showed that both PPIs and vonoprazan were positively associated with CDI, with odds ratios of 3.15 and 2.63, respectively. The overall CDI incidence rate was 1.42/10,000 patient-days, which was comparable to previous reports. Matched subgroup analyses showed that PPIs and vonoprazan had equivalent magnitudes of association with CDI.
These findings are significant because they suggest that the use of vonoprazan, which is widely available in Asian countries, may also be associated with CDI. Therefore, further studies on the association of its usage with CDI are warranted. Moreover, the comparable magnitude of association between PPIs and vonoprazan with CDI highlights the need for careful consideration when selecting acid suppressants for patients, especially those at high risk for CDI.
Source:
Saruta, Y., Watanabe, K., Tsuji, T., Takahashi, Y., Matsuzawa, H., Yoshida, T., Takahashi, S., Shimodaira, Y., Matsuhashi, T., & Iijima, K. (2023). Vonoprazan poses no additional risk of developing Clostridioides difficile infection compared to proton pump inhibitors. In Journal of Gastroenterology and Hepatology. Wiley. https://doi.org/10.1111/jgh.16169