Overuse of stress ulcer prophylaxis in the critical care setting and beyond

Farrell, C.; Mercogliano, Giancarlo; Kuntz, Catherine

doi:10.1016/j.jcrc.2009.05.014

Cited by 55 publications

(48 citation statements)

References 26 publications

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“…14,16,17 Omeprazole and ranitidine were the only 2 AST agents available at Imam Khomeini Hospital during the period of the present study and were used in nearly equal proportions in the pre-intervention period and a slightly higher proportion of omeprazole in the post-intervention period. The initial ASHP guidelines (1999) recommended that the selection of an AST agent of choice for SUP should be made by each institution based on analysis of the side effects and actual 8 reinforced the point that the AST agent of choice should be based primarily on actual cost because there was not sufficient evidence of a difference in efficacy for SUP. 16 Although there appears to be no evidence of superiority of PPIs over H2RAs in SUP, 18 PPIs have become the most commonly used medications for SUP.…”

Section: ■■ Discussionmentioning

confidence: 99%

“…[6][7][8] Although it is generally believed that AST is harmless, it is not without adverse effects. Some studies have described an association between use of gastric acid-suppressive agents, particularly proton pump inhibitors (PPIs) such as omeprazole, and increased risk for Clostridium difficile-associated disease (CDAD) and community-acquired pneumonia (CAP).…”

Section: What Is Already Known About This Subject R E S E a R C Hmentioning

confidence: 99%

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Descriptive Analysis of a Clinical Pharmacy Intervention to Improve the Appropriate Use of Stress Ulcer Prophylaxis in a Hospital Infectious Disease Ward

Khalili¹,

Dashti‐Khavidaki²,

Talasaz³

et al. 2010

JMCP

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BACKGROUND: Stress ulcers are acute superficial inflammatory lesions of the gastric mucosa induced when an individual is subjected to unusually high physiologic demands. In recent years, use of acid suppression therapy (AST) for stress ulcer prophylaxis (SUP) in inpatient settings other than intensive care has become increasingly common, leading to increased drug cost and an avoidable increased risk of adverse events such as hospitalacquired pneumonia.

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Section: ■■ Discussionmentioning

confidence: 99%

Section: What Is Already Known About This Subject R E S E a R C Hmentioning

confidence: 99%

Descriptive Analysis of a Clinical Pharmacy Intervention to Improve the Appropriate Use of Stress Ulcer Prophylaxis in a Hospital Infectious Disease Ward

Khalili¹,

Dashti‐Khavidaki²,

Talasaz³

et al. 2010

JMCP

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“…Tal es el caso de los pacientes en estado de sepsis con los cuales no hay suficientes estudios para recomendar profilaxis frente a la úlcera por estrés (53,54). En un intento de establecer su verdadera utilidad, Krag y colaboradores realizaron una revisión sistemática en la que encontraron que no hay una diferencia estadística-mente significativa entre el placebo y la profilaxis en cuanto a mortalidad por sangrado gastrointestinal y aparición de neumonía.…”

Section: Discussionunclassified

Uso de inhibidores de la bomba de protones y antagonistas de los receptores H2 de histamina como profilaxis en úlceras por estrés: ¿una práctica justificada?

Chaves

Nivia

2015

Rev. Colomb. Enferm.

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La introducción de los moduladores de acidez gástrica como profilaxis contra las úlceras por estrés en pacientes críticos se ha ido convirtiendo en una práctica de rutina tanto en la unidad de cuidados intensivos como fuera de esta; sin embargo, el desconocimiento de la fisiopatología de la enfermedad, las indicaciones de uso de moduladores de pH como profilácticos, los riesgos asociados a la prescripción indiscriminada y de las guías disponibles sobre esta práctica han llevado a un uso descontrolado de medicamentos como omeprazol y ranitidina, lo cual aumenta los costos para los hospitales y predispone a los pacientes a presentar enfermedades como neumonía. Con el objetivo de revisar los factores de riesgo asociados a esta patología, la eficacia de esta medida, sus indicaciones y posibles complicaciones tanto dentro como fuera de las unidades de cuidados intensivos, se realizó una revisión de la literatura. Esta incluyó artículos disponibles en diferentes bases de datos que hicieran referencia al manejo profiláctico de úlceras por estrés desde 1980 hasta 2014. Se encontró que, según la literatura actual, el uso de la profilaxis contra úlceras por estrés es una práctica muy debatida en el caso de los pacientes críticos y, lo que es más importante, en los no críticos aún no existen recomendaciones de uso o factores de riesgo establecidos. Por esta razón, la extrapolación de esta conducta a pacientes fuera de la unidad de cuidados intensivos es injustificada hasta el momento

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“…Also, in a Jordanian study that aimed to assess the incidence of PPIs overprescribing for SUP; it has been found that the majority of the patients were irrationally given PPI (Alqudah et al, 2016). The overutilization of PPIs therapy may increase the incidence of potential adverse drug reactions and raise the cost of treatment for both hospital management and patient (Farrell et al, 2010). PPIs overuse may potentially lead to bone fractures, headaches, and gastrointestinal infections (Ramirez et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Proton Pump Inhibitors Prescribing among Non-Critically Ill Hospitalized Patients in a Malaysian Tertiary Hospital

2017

J App Pharm Sci

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Background: There are raised concerns regarding the rational guidelines-based prescribing of proton pump inhibitors (PPIs) therapy in the hospital setting.Objective: To describe the current prescribing practice of PPIs among hospitalized patients in non-intensive care settings. Also, the study aimed to evaluate the appropriateness of the prescribed PPIs. Methods:A cross-sectional study was conducted in the medical ward of a tertiary hospital in the state of Pahang, Malaysia. A total of 153 medical records of non-critically-ill adult patients receiving PPI therapy were investigated. The assessment of PPI prescribing was performed referring to clinical guidelines and the list of PPI-approved indications. Results:The most frequently prescribed PPI regimen has been pantoprazole 40 mg OD. Approximately 34% of the prescribed regimens were considered to be appropriate as it was consistent with the clinical guidelines. However, about 31% of the prescribed PPIs did not have a clear indication. Moreover, the inappropriate use of PPIs was revealed in nearly 19% of the total PPIs prescriptions. Finally, 16% of the prescribed PPIs were in need of dosage adjustment due to the presence of drug-drug interactions with the concurrently used medications. Conclusion:Inappropriately prescribed PPIs are prevalent among non-critically ill-hospitalized adult patients in a Malaysian tertiary hospital. Initiatives for enforcing rational prescribing should focus on the proper documentation of evidence-based indications of PPIs in the medical records. There is a desperate need in the local setting for well-defined PPIs prescribing criteria. Future research should design and examine the impact of prescribing improvement interventions on the PPIs rational prescribing.

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Overuse of stress ulcer prophylaxis in the critical care setting and beyond

Cited by 55 publications

References 26 publications

Descriptive Analysis of a Clinical Pharmacy Intervention to Improve the Appropriate Use of Stress Ulcer Prophylaxis in a Hospital Infectious Disease Ward

Descriptive Analysis of a Clinical Pharmacy Intervention to Improve the Appropriate Use of Stress Ulcer Prophylaxis in a Hospital Infectious Disease Ward

Uso de inhibidores de la bomba de protones y antagonistas de los receptores H2 de histamina como profilaxis en úlceras por estrés: ¿una práctica justificada?

Evaluation of Proton Pump Inhibitors Prescribing among Non-Critically Ill Hospitalized Patients in a Malaysian Tertiary Hospital

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