Overuse of acid-suppressive therapy in hospitalized patients

Nardino, Robert J.

doi:10.1016/s0002-9270(00)01472-6

Cited by 71 publications

(125 citation statements)

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“…29,30 Therefore, the risk ⁄ benefit analysis strongly favours PPI use in a low CDI endemicity setting. Not withstanding the foregoing, PPI or AST prescriptions have been found to be of questionable indication in 41-69% of hospitalized patients, [31][32][33][34][35] indicating that prescribing needs to be more selective and duration of use should be limited to maximize risk benefits. In support of selective prescribing, the risk of CDI is extremely low in those receiving PPI for Zollinger-Ellison syndrome 36 suggesting that a valid indication may be associated with increased benefit and reduced risk.…”

Section: Discussionmentioning

confidence: 99%

Proton pump inhibitors increase significantly the risk of Clostridium difficile infection in a low‐endemicity, non‐outbreak hospital setting

Dalton

Lye-Maccannell

Henderson

et al. 2009

Aliment Pharmacol Ther

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Section: Discussionmentioning

confidence: 99%

Proton pump inhibitors increase significantly the risk of Clostridium difficile infection in a low‐endemicity, non‐outbreak hospital setting

Dalton

Lye-Maccannell

Henderson

et al. 2009

Aliment Pharmacol Ther

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“…According to each author's criteria, 65% to 70% of these patients had no true indication for these acid-lowering drugs. Furthermore, 50% to 55% of the patients without an indication were continued on acidsuppressive therapy in the outpatient setting [4][5][6] . Although proton pump inhibitors (PPIs) are generally well-tolerated and clearly the most effective available agents used in the treatment of gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), Helicobacter Pylori infections and other hypersecretory conditions, their use does not come without risks.…”

Section: Introductionmentioning

confidence: 99%

Proton pump inhibitor-associated pneumonia: Not a breath of fresh air after all?

Fohl

Regal²

2011

WJGPT

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Over the past two decades, proton pump inhibitors (PPIs) have emerged as highly effective and relatively safe agents for the treatment of a variety of gastrointestinal disorders. Unfortunately, this desirable pharmacological profile has also contributed to superfluous and widespread use in both the inpatient and outpatient settings. While generally well-tolerated, research published over the last decade has associated these agents

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“…Only a small number of studies have examined the effectiveness of this prophylactic attitude in non-ICU patients [9,15], as well as its cost impact [16,17], and none were proper prospective controlled studies. These studies have shown a higher incidence of bleeding, but there were major differences in the populations considered in each one.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, evidence of their benefit in the prophylaxis of bleeding from stress-related mucosal disease is lacking. Despite this, omeprazole and other PPIs are commonly used for this purpose, either in critical care or in general medical wards [9].…”

Section: Introductionmentioning

confidence: 99%

Stress-related mucosal disease: Incidence of bleeding and the role of omeprazole in its prophylaxis

Amaral

Favas

Alves

et al. 2010

European Journal of Internal Medicine

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Background: Upper gastrointestinal bleeding is the severe complication of stress-related mucosal disease in hospitalized patients. In intensive care units (ICU), risk factors are well defined and only mechanical ventilation and coagulopathy proved to be relevant for significant bleeding. On the contrary, in non-ICU settings there is no consensus about this issue. Nevertheless, omeprazole is still widely used in prophylaxis of bleeding. The objective of our study was to evaluate the relevance of stress-related mucosal disease bleeding in patients admitted to an internal medicine ward, and the role of omeprazole in its prophylaxis. Methods: We conducted a retrospective study in which we analysed consecutive patients who were admitted to our ward over a year. We recorded demographic characteristics of the patients, potential risk factors for stress-related mucosal disease (clinical data, laboratory, and medication), administration of prophylactic omeprazole, and total cost of this prophylaxis. Patients with active gastrointestinal bleeding on the admission were excluded. We recorded every upper gastrointestinal bleeding event with clinical relevance. Results: Five hundred and thirty-five patients, mean age 70 years, mean length of stay 9.6 ± 7.7 days; 140 (26.2%) patients were treated with 40 mg of omeprazole intravenously, 193 (36.1%) with 20 mg of omeprazole orally, and 202 (37.8%) patients had no prophylaxis. There was only one episode (0.2%) of clinically relevant bleeding. Conclusion: In patients admitted to an internal medicine ward, incidence of upper gastrointestinal bleeding as a complication of stress-related mucosal disease is low. We found that there is no advantage in prophylaxis with omeprazole.

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Overuse of acid-suppressive therapy in hospitalized patients

Cited by 71 publications

References 0 publications

Proton pump inhibitors increase significantly the risk of Clostridium difficile infection in a low‐endemicity, non‐outbreak hospital setting

Proton pump inhibitors increase significantly the risk of Clostridium difficile infection in a low‐endemicity, non‐outbreak hospital setting

Proton pump inhibitor-associated pneumonia: Not a breath of fresh air after all?

Stress-related mucosal disease: Incidence of bleeding and the role of omeprazole in its prophylaxis

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