Antibiotics and acid suppression therapy in adults

• 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.

4C ANTIBIOTICS: COAMOXICLAV, CIPROFLOXACIN, CLINDAMYCIN, CEPHALOSPORINS

• • 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.