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(from Clostridium Difficile and Older Adults: What Primary Care Providers Should Know, July 1998) Table 1. Major Risk Factors for Clostridium Difficile-Associated Diarrhea Over-the-counter drug use3   Laxatives   Histamine inhibitors (reduce gastric acid barrier) Antibiotic use: factors   Broad-spectrum   Intensity of use   Duration of use   Multiple drug therapy Narcotic use (decreases gastrointestinal [GI] motility, possibly slowing transit of clostridial spores, thereby promoting colonization)23 Chemotherapy13 Increased age (65 or older) Procedures undergone   Enema   Nasogastric tube insertion   Upper GI tract surgery   GI manipulations   Endoscopy Concurrent disease or condition3, 13   Dysautonomia   Diabetes mellitus   Liver or renal failure   Leukemia or lymphoma   Inflammatory bowel disease

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