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Title: The Association between Histamine 2 Receptor Antagonist Use and Clostridium difficile Infection: A Systematic Review and Meta-analysis
Authors: Tleyjeh, I. M.
Abdulhak, A. B.
Riaz, M.
Garbati, M. A.
Al-Tannir, M.
Alasmari, F. A.
Alghamdi, M.
Khan, A. R.
Erwin, P. J.
Sutton, A. J.
Baddour, L. M.
First Published: 4-Mar-2013
Publisher: Public Library of Science
Citation: PLoS One, 2013, 8 (3), e56498
Abstract: BACKGROUND: Clostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid suppression therapy and development of CDI. PURPOSE: We sought to systematically review the literature that examined the association between histamine 2 receptor antagonists (H2RAs) and CDI. DATA SOURCE: We searched Medline, Current Contents, Embase, ISI Web of Science and Elsevier Scopus from 1990 to 2012 for all analytical studies that examined the association between H2RAs and CDI. STUDY SELECTION: Two authors independently reviewed the studies for eligibility. DATA EXTRACTION: Data about studies characteristics, adjusted effect estimates and quality were extracted. DATA SYNTHESIS: Thirty-five observations from 33 eligible studies that included 201834 participants were analyzed. Studies were performed in 6 countries and nine of them were multicenter. Most studies did not specify the type or duration of H2RAs therapy. The pooled effect estimate was 1.44, 95% CI (1.22-1.7), I(2) = 70.5%. This association was consistent across different subgroups (by study design and country) and there was no evidence of publication bias. The pooled effect estimate for high quality studies was 1.39 (1.15-1.68), I2 = 72.3%. Meta-regression analysis of 10 study-level variables did not identify sources of heterogeneity. In a speculative analysis, the number needed to harm (NNH) with H2RAs at 14 days after hospital admission in patients receiving antibiotics or not was 58, 95% CI (37, 115) and 425, 95% CI (267, 848), respectively. For the general population, the NNH at 1 year was 4549, 95% CI (2860, 9097). CONCLUSION: In this rigorous systematic review and meta-analysis, we observed an association between H2RAs and CDI. The absolute risk of CDI associated with H2RAs is highest in hospitalized patients receiving antibiotics.
DOI Link: 10.1371/journal.pone.0056498
eISSN: 1932-6203
Version: Publisher Version
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2013 Tleyjeh et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Description: Correction: 2 Apr 2013: Tleyjeh IM, Abdulhak AAB, Riaz M, Garbati MA, Al-Tannir M, et al. (2013) Correction: The Association between Histamine 2 Receptor Antagonist Use and Clostridium difficile Infection: A Systematic Review and Meta-analysis. PLoS ONE 8(4): 10.1371/annotation/56f8945c-33f6-45bf-87ce-dd512f7c25b0 Available at
Appears in Collections:Published Articles, Dept. of Health Sciences

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