ASHP Therapeutic Guidelines on Stress Ulcer Prophylaxis

Audit on Practices of Stress Ulcer Prophylaxis in Intensive Care Unit Patients

“…However, as early as 1999, the AHSP guidelines do not support SUP for adult patients in non-ICU settings. 1 Rafinazari et al also reported that, in their study, 38.5% of patients did not receive appropriate SUP on ICU admission and 81.2% continued on inappropriate SUP upon transfer from ICU. 18 Wohlt et al reported that 394 patients met the eligibility criteria for SUP, 357 patients were prescribed SUP, and 80% continued SUP on transfer from ICU.…”

“…Prophylaxis was also recommended for ICU patients with a Glasgow coma score of ≤ 10 (or the inability to obey simple commands), thermal injuries to >35% of their body surface area (BSA), following partial hepatectomy, ICU patients with polytrauma (e.g., injury severity score of ≥ 16), transplantation patients in the ICU perioperatively, and ICU patients with hepatic failure and with spinal cord injuries. 1 They also delineated independent risk factors for GI bleed in which treatment rather than prophylaxis with acid suppressing drugs is indicated. These included Zollinger-Ellison syndrome, acute upper GI bleed, erosive esophagitis, Helicobacter pylori treatment, gastric or duodenal ulcer, gastroesophageal reflux disease, and regular scheduled use of an acid-suppressing medication prior to admission.…”

“…These included Zollinger-Ellison syndrome, acute upper GI bleed, erosive esophagitis, Helicobacter pylori treatment, gastric or duodenal ulcer, gastroesophageal reflux disease, and regular scheduled use of an acid-suppressing medication prior to admission. 1 However, by the year 2000s, the scenario seemed to have changed. Quenot et al evaluated the use of SUP in critically ill ICU patients and reiterated that the mechanism of stress ulceration is multifactorial and incompletely understood.…”

“…According to the ASHP guidelines, the drug of choice among antacids, H2-receptor blockers, and sucralfate for use, as SUP should be made on an institutional basis, taking into consideration the route of administration (is enteral possible), potential side effects, and the cost factor. 1 When considering the choice of drug, in various metaanalyzes, the use of PPI for SUP has been found to be associated with a significantly lower rate of CSGIB compared to an H2RA. [22][23][24] The main concern associated with use of a PPI in the ICU is the higher risk of infections, particularly, pneumonia and C. difficile probably due to the attenuation of gastric acid protection against bacteria.…”

“…The first and the last guideline regarding the use of SUP in the ICU was published in 1999 by the American Society of Health-system Pharmacists (ASHP). 1 Since then, there has been no further update. No clear recent guidelines are available regarding the use of SUP in critically ill ICU patients.…”