The Inappropriate Prescription of Oral Proton Pump Inhibitors in the Hospital Setting: A Prospective Cross-Sectional Study
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Proton pump inhibitors (PPIs) are used to treat upper gastrointestinal tract disorders. Their efficacy and perceived safety have led to widespread prescription. This is not without effect, in terms of adverse events and resource utilization.
To prospectively assess oral PPI prescription in hospitalized patients.
PPI prescription in consecutive hospitalized patients was assessed. Indication and dose were assessed by patient interview and medical record review. Comparisons with current published prescribing guidelines were made.
Four hundred and forty-seven patients were included. 57.5 % were prescribed PPIs. 26.8 % prescriptions were for inappropriate or unclear indications. 68.4 % were on higher doses than guidelines recommended, of which 41.6 % could have undergone dose reduction, and 26.5 % discontinued. In a multivariate analysis, age, gender, and length of stay had no association with PPI prescription. Although aspirin use was appropriately associated with PPI prescription (RR: 1.8, 95 % CI 1.127–3.69; p < 0.05), the PPI was often given at higher than recommended doses (p < 0.001). This may reflect older age and multiple risk factors in this subset. Surgical patients commenced more PPIs and at higher dosages (p < 0.001). Omeprazole and lansoprazole were most often inappropriately prescribed (p < 0.01, p < 0.001, respectively).
Inappropriate PPI therapy is still a problem in hospitals, though it appears to be at a lower level compared with previous studies. Awareness of evidence-based guidelines and targeted medicine reconciliation strategies are essential for cost-effective and safe use of these medications.
KeywordsProton pump inhibitors Inappropriate prescribing Prescribing patterns Physician Inpatients
Proton pump inhibitor
Peptic ulcer disease
Gastro-esophageal reflux disease
Conflict of interest
- 3.Aseeri M, Schroeder T, Kramer J, Zackula R. Gastric acid suppression by proton pump inhibitors as a risk factor for clostridium difficile-associated diarrhea in hospitalized patients. Am J Gastroenterol. 2008;103:2308–2313.Google Scholar
- 5.IMS Health Report. Leading therapy classes by global pharmaceutical sales. http://www.imshealth.com/ims/portal/front/articleC/0,2777,6025_80528184_80530441,00.html; 2006.
- 6.National Health Service. PACT centre pages. Drugs for dyspepsia. www.ppa.nhs.uk//news/pact-082004.htm; 2006.
- 9.National Institute for Clinical Excellence. Dyspepsia: managing dyspepsia in adults in primary care. London: NICE; 2004.Google Scholar
- 10.BNF no. 66, September 2013–March 2014 ISBN-13: 978-0857110855.Google Scholar
- 12.Molloy D, Molloy A, O’Loughlin C, Falconer M, Hennessy M. Inappropriate use of proton pump inhibitors. Ir J Med Sci. 2010;179:73–75. doi: 10.1007/s11845-009-0426-1.
- 13.Thomas L, Culley EJ, Gladowski P, Goff V, Fong J, Marche SM. Longitudinal analysis of the costs associated with inpatient initiation and subsequent outpatient continuation of proton pump inhibitor therapy for stress ulcer prophylaxis in a large managed care organization. J Manag Care Pharm. 2010;16:122–129.PubMedGoogle Scholar
- 15.Kaye K, Easton-Carter K, Brien J, Day R. An investigation of hospital prescribing of proton pump inhibitors[Internet]. Sydney: NSW Therapeutic Assessment Group. http://www.ciap.health.nsw.gov.au/nswtag/publications/reports/ppi_project_exec_summary_fv-0701.pdf; 2001.
- 18.Campbell F, Karnon J, Czoski-Murray C, Jones R. A systematic review of the effectiveness and cost-effectiveness of interventions aimed at preventing medication error (medicines reconciliation) at hospital admission. The University of Sheffield, School of Health and Related Research (ScHARR). J Eval Clin Pract. 2009;15:299–306.PubMedCrossRefGoogle Scholar