Inappropriate utilization of intravenous proton pump inhibitors in hospital practice--a prospective study of the extent of the problem and predictive factors

Craig, Douglas A.; Thimappa, R; Anand, Vidhu; Sebastian, S

doi:10.1093/qjmed/hcq019

Cited by 37 publications

(48 citation statements)

References 25 publications

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“…Although one criterion was used to assess the appropriateness of the route of administration during the pre-restriction period, the dramatic decrease in the number of IV vials dispensed during post-restriction period justified the pharmacist initial concern on the large consumption of esomeprazole IV vials. Inappropriate use of IV PPIs can lead to increased cost burden and potential adverse effects, while oral forms has been associated with several advantages over the IV route including lower cost, less utilization of hospital resources, similar clinical outcomes for most indications and less IV related complications [2,6].…”

Section: Discussionmentioning

confidence: 99%

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Cost reduction associated with restriction policy on dispensing intravenous esomeprazole in lebanon

2010

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Section: Discussionmentioning

confidence: 99%

“…Inappropriate use of IV PPIs can lead to increased cost burden, drug shortages, and potential adverse effects. [2]. Esomeprazole intravenously remains an alternative to oral esomeprazole with similar tolerability and healing rates when used for short-term period in patients with erosive esophagitis who cannot tolerate oral medications [5].…”

Section: Introductionmentioning

confidence: 99%

Cost reduction associated with restriction policy on dispensing intravenous esomeprazole in lebanon

2010

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“…With these new recommendations, a dramatic increase in both oral and intravenous PPI use has been observed across the globe over recent years (Gingold et al, 2004; Hoover, Schumaker & Franklin, 2009; Slattery et al, 2007). However, several studies have demonstrated that 25–75% of patients receiving PPIs, particularly intravenous preparations, had no appropriate indication (Craig et al, 2010; Hoover, Schumaker & Franklin, 2009; Slattery et al, 2007). This emerging trend is worrisome as it reflects high rates of inappropriate prescribing of PPIs in hospitals, leading to drug waste which could have otherwise been prevented (Forgacs & Loganayagam, 2008; Nasser, Nassif & Dimassi, 2010).…”

Section: Introductionmentioning

confidence: 99%

“…Several audits on the appropriateness of intravenous PPIs have been conducted in the United States (Hoover, Schumaker & Franklin, 2009; MacLaren et al, 2006), Canada (Afif et al, 2007), Europe (Craig et al, 2010; Slattery et al, 2007) and the Middle East (Alsultan et al, 2010). Some studies were retrospective (Afif et al, 2007; Chavez-Tapia et al, 2008; MacLaren et al, 2006; Naunton, Peterson & Bleasel, 2000), whilst others were prospective (Alsultan et al, 2010; Sebastian et al, 2003; Slattery et al, 2007) in study design.…”

Section: Introductionmentioning

confidence: 99%

Unexplained abdominal pain as a driver for inappropriate therapeutics: an audit on the use of intravenous proton pump inhibitors

Lai

Wong

Low

et al. 2014

PeerJ

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Background. Proton pump inhibitors (PPIs) are currently the most effective agents for acid-related disorders. However, studies show that 25–75% of patients receiving intravenous PPIs had no appropriate justification, indicating high rates of inappropriate prescribing.Objective. To examine the appropriate use of intravenous PPIs in accordance with guidelines and the efficacy of a prescribing awareness intervention at an Asian teaching institution.Setting. Prospective audit in a tertiary hospital in Malaysia.Method. Every 4th intravenous PPI prescription received in the pharmacy was screened against hospital guidelines. Interventions for incorrect indication/dose/duration were performed. Patients’ demographic data, medical history and the use of intravenous PPI were collected. Included were all adult inpatients prescribed intravenous PPI.Main Outcome Measure. Proportion of appropriate IV PPI prescriptions.Results. Data for 106 patients were collected. Most patients were male [65(61.3%)], Chinese [50(47.2%)], with mean age ± SD = 60.3 ± 18.0 years. Most intravenous PPI prescriptions were initiated by junior doctors from the surgical [47(44.3%)] and medical [42(39.6%)] departments. Only 50/106(47.2%) patients had upper gastrointestinal endoscopy/surgery performed to verify the source of bleeding. Unexplained abdominal pain [81(76.4%)] was the main driver for prescribing intravenous PPIs empirically, out of which 73(68.9%) were for suspected upper gastrointestinal bleed. Overall, intravenous PPI was found to be inappropriately prescribed in 56(52.8%) patients for indication, dose or duration. Interventions on the use of intravenous PPI were most effective when performed by senior doctors (100%), followed by clinical pharmacists (50%), and inpatient pharmacists (37.5%, p = 0.027).Conclusion. Inappropriate intravenous PPI usage is still prevalent despite the enforcement of hospital guidelines. The promotion of prescribing awareness and evidence-based prescribing through education of medical staff could result in more judicious use of intravenous PPI and dose-optimization.

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“…A Tabela 3 mostra uma comparação entre os IBPs e os ARH2s. O uso de IBPs para profilaxia de sangramento GI relacionado ao estresse em pacientes de terapia intensive têm sido criticado em geral pela disseminação de sua prática e em especial pelo prolongamento de sua prescrição após encerrada a fase de maior risco 6,10,15,17 . Pelo exposto, o uso judicioso dessa poderosa ferramenta em pacientes selecionados parece estar indicado.…”

Section: Ibp (Inibidores Da Bomba De Prótons)unclassified

Profilaxia das úlceras associadas ao estresse

Pompílio

Cecconello

2010

ABCD, arq. bras. cir. dig.

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DESCRITORESÚlcera duodenal. Terapêutica. Inibidores da bomba de prótons.RESUMO -Introdução -As úlceras da mucosa gastroduodenal que aparecem após graves insultos têm sido chamadas de úlceras associadas ao estresse ou, mais genericamente, de "doença mucosa associada ao estresse" (DMAE). São conhecidas desde a Antiguidade e apesar de relacionarem-se com altos índices de morbidade e mortalidade, esquemas de profilaxia no intuito de minimizar seus riscos, só foram introduzidos recentemente. Os inibidores da bomba de prótons têm desempenhado papel importante nesse cenário. Métodos -O presente artigo é uma breve revisão sobre seu uso dentro do contexto clínico da profilaxia do sangramento gastrointestinal relacionado ao estresse.ABSTRACT -Introduction -Gastroduodenal mucosal ulcers that appear after severe insults have been called ulcers associated with stress or, more generally, "mucosal disease associated with stress" (DMAE). Are known since antiquity and although linked with high morbidity and mortality, prevention schemes in order to minimize their risk, were introduced only recently. The proton pump inhibitors have played an important role in this scenario. Methods -This article is a brief review of its use within the clinical context of prophylaxis of gastrointestinal bleeding due to stress. INTRODUÇÃOA s úlceras da mucosa gastroduodenal que aparecem após graves insultos -como queimaduras, choque séptico e grandes traumatismos, por exemplo -, têm sido chamadas de úlceras associadas ao estresse ou, mais genericamente, de doença mucosa associada ao estresse (DMAE). São conhecidas desde a Antiguidade e apesar de relacionarem-se com altos índices de morbidade e mortalidade, esquemas de profilaxia no intuito de minimizar seus riscos, só foram introduzidos recentemente. Os inibidores da bomba de prótons (IBP) têm desempenhado um papel importante nesse cenário. O presente artigo é uma breve revisão sobre seu uso dentro do contexto clínico da profilaxia do sangramento gastrointestinal (GI) relacionado ao estresse. Curling, Cushing e AlémA primeira descrição de DMAE foi de Curling em 1842 7 . Esse autor descreveu úlceras duodenais associadas a queimaduras como uma entidade clínica à parte do espectro clássico da doença péptica, embora ele mesmo admita que Dupuytren, dez anos antes, tenha chamado a atenção para ulcerações intestinais em pacientes que sobreviviam de lesões produzidas por queimaduras. Quase um século se passou para que um novo dado pudesse ser acrescentado a essa questão. Segundo Harvey Cushing, foi Carl von Rokitansky quem primeiro chamou a atenção para a associação entre ulceração péptica e lesões cerebrais ou meníngeas. Em seu estudo clássico de 1932 9 , Cushing mostrou onze casos de patologia cerebral nos quais, à autopsia, foram encontradas ulcerações no trato

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Inappropriate utilization of intravenous proton pump inhibitors in hospital practice--a prospective study of the extent of the problem and predictive factors

Abstract: This study suggests that the majority of IV PPI prescriptions in hospital are inappropriate, particularly when initiated for non-UGI bleeding indications. Improving prescribing awareness through education of junior medical staff on non-medical wards could reduce inappropriate IV PPI use.

Cited by 37 publications

References 25 publications

Cost reduction associated with restriction policy on dispensing intravenous esomeprazole in lebanon

Cost reduction associated with restriction policy on dispensing intravenous esomeprazole in lebanon

Unexplained abdominal pain as a driver for inappropriate therapeutics: an audit on the use of intravenous proton pump inhibitors

Profilaxia das úlceras associadas ao estresse

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