The status of proton pump inhibitor use: a prescription survey of 45 hospitals in China

Abstract

Background: proton pump inhibitors (PPI) have been widely used in the clinic but inappropriate prescribing has also increased dramatically. Objective: to describe the prescribing patterns and assess the appropriateness of the p rescribed PPI use in 45 hospitals in China. Materials and methods: PPI prescriptions for non-hospitalized patients were collected from hospitals in Beijing, Chengdu, Guangzhou and Hangzhou of China over a 40-day period in 2016. These data were analyzed using the prescription number, proportion and economic indicators (defined daily dose system [DDD], defined daily cost [DDC] and drug utilization index [DUI]). The evaluation criteria of PPI use was based on Martindale: The Complete Drug Reference, New Materia Medica and drug instructions. Results: in total, 357,687 prescriptions using oral PPI and 38,216 prescriptions using injectable PPI were assessed. The average age of PPI users was 53 years. The most commonly used oral PPI was rabeprazole, while the most common injectable PPI was pantoprazole. The DDD of oral rabeprazole and DDC of injectable rabeprazole were the highest. Meanwhile, only the DUI values of oral rabeprazole, lansoprazole and ilaprazole were less than 1.0. The clinical diagnosis of some users included well identified risky comorbidities such as kidney disease (2.9%). Furthermore, between 32.6% and 56.8% of the PPI prescriptions were used for inappropriate indications. Conclusion: this survey demonstrated that PPI use was accompanied by unapproved indications and excessive dosages. Comprehensive measures are urgently needed to improve PPI use and reduce unnecessary drug costs.

Use of Proton Pump Inhibitors in Hungary: Mixed-Method Study to Reveal Scale and Characteristics

“…In the Icelandic study, 95% of patients started high dose PPI (they defined this “high dose” category as standard dose or high dose), and 21% remained on that treatment after 1 year ( Halfdanarson et al., 2018 ). Similar overdosing of PPIs has been reported from China ( Ying et al., 2019 ).…”

“…Other studies from inpatients reported a high discordance from evidence-based indications of PPI use (Pillans et al, 2000;Chia et al, 2014;Meli et al, 2015;Lodato et al, 2016;Pujal Herranz, 2016;van den Bemt et al, 2016;Ying et al, 2019). In the expert review of Savarino et al PPIs are considered as "harmless, cheap remedy for any digestive problems by doctors" (Savarino et al, 2018a).…”

“…Different PPI products have an equivalent mechanism of action and a similar clinical efficacy (Strand et al, 2017). Due to their excellent efficacy, tolerability and positive adverse event profile, PPI utilization has significantly increased all over the world (Hollingworth et al, 2010;Tett et al, 2013;Lanas, 2016;Ying et al, 2019). Besides official, evidence-based use of PPIs, less understandable and justifiable prescriptions have also occurred (Savarino et al, 2017;Savarino et al, 2018a).…”

“…Potential long-term side effects, increasing medical expenses, and potential drug interactions ( Hu et al., 2018 ) justify the recognition and analysis of the trends and characteristics of PPI utilization. Utilization of PPIs has been analyzed in many countries ( Pillans et al., 2000 ; Chia et al., 2014 ; Larsen et al., 2014 ; Kelly et al., 2015 ; Meli et al., 2015 ; Lodato et al., 2016 ; Pottegard et al., 2016 ; Pujal Herranz, 2016 ; Juntunen et al., 2017 ; Del Giorno et al., 2018 ; Halfdanarson et al., 2018 ; Luo et al., 2018 ; Ying et al., 2019 ), but no data from Hungary has been published yet, as emphasized in the study of Igaz et al. (2018) .…”

Continuous improvement on the rationality of prophylactic injectable PPIs usage by a clinical pharmacist-led guidance team at a Chinese tertiary teaching hospital

“… 7 In recent years, the irrational use of PPIs has become common in China, mainly involving unapproved indications and excessive dosages. 8 , 9 In addition, the negative effects of PPI use are generally underestimated owing to marketing and reporting bias in published trials. Widespread and inappropriate use of PPIs is likely to translate into serious long-term adverse effects such as increased gastrointestinal tract infections (e.g., Clostridium difficile -associated diarrhea), reduced intestinal absorption of vitamins and minerals, pneumonia, increased fracture risks, 10 – 14 kidney damage 15 , 16 and liver adverse effects.…”