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Non‐steroidal anti‐inflammatory drugs and the risk of Clostridium difficile ‐associated disease
Author(s) -
Suissa Daniel,
Delaney Joseph A. C.,
Dial Sandra,
Brassard Paul
Publication year - 2012
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/j.1365-2125.2012.04191.x
Subject(s) - odds ratio , medicine , diclofenac , clostridium difficile , population , case control study , confidence interval , intensive care medicine , antibiotics , pharmacology , environmental health , biology , microbiology and biotechnology
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Increasing age, length of hospital stay and previous antibiotic use have been established as important risk factors in the development of Clostridium difficile associated disease (CDAD). Several case reports over the past 30 years have linked diclofenac, a non‐steroidal anti‐inflammatory drug (NSAID) with CDAD. We assessed whether NSAID use in general, and diclofenac use in particular, is associated with an increased risk of CDAD. WHAT THIS STUDY ADDS • In this population based study, the use of diclofenac was associated with a 35% increase in the risk of developing CDAD. This association persisted when we limited the analysis to non‐hospitalized patients. No association was found between the use of any other NSAIDs and the risk of CDAD. AIM Several case reports have linked diclofenac, a non‐steroidal anti‐inflammatory drug (NSAID), with Clostridium difficile associated disease (CDAD). We assessed whether NSAID use in general, and diclofenac use in particular, is associated with an increased risk of CDAD. METHODS We used the United Kingdom's General Practice Research Database (GPRD) to conduct a population‐based case–control study. All cases of CDAD occurring between 1994 and 2005 were identified and were matched to 10 controls each. Conditional logistic regression was used to estimate the odds ratio of CDAD associated with current NSAID use, adjusting for covariates. RESULTS We identified 1360 CDAD cases and 13 072 controls. We found an increased risk of CDAD associated with diclofenac (adjusted odds ratio (RR) 1.35, 95% confidence interval (CI) 1.10, 1.67). We did not observe an increased risk of CDAD with use of any other NSAID. No dose–response for diclofenac exposure was found. When we analyzed only patients who were not hospitalized in the year before the index date, we found diclofenac to have a similar effect on CDAD risk (adjusted RR 1.43, 95% CI 1.11, 1.84). CONCLUSION Diclofenac use is associated with a modest increase in the risk of CDAD. In patients at risk of CDAD, other NSAIDs could be prescribed.