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Rates of Clostridium difficile–associated disease (CDAD) are rising sharply, with an increasing number of cases in patients lacking the usual risk factors of antibiotic use and hospitalization. Some studies have suggested that the use of proton-pump inhibitors (PPIs) may pose a heretofore unrecognized risk for outpatient infection.
From 1994 through 2004, a total of 317 outpatients who were registered in a giant British primary care database received prescriptions for oral vancomycin (whose only medical indication is treatment for CDAD). Almost half the patients had no record of receiving other antibiotics within 3 months of receiving vancomycin. Compared with age-matched controls from the same database, these patients were three times as li…