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Volume 2024, Issue 4
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Background: Proton pump inhibitors (PPIs) are commonly prescribed to hospitalized patients, but many of these prescriptions may not be based on evidence-based indications. It’s important to understand that inappropriate prescribing of PPIs can lead to unnecessary medications and financial burdens. Unfortunately, there are not many recent studies exploring how often PPIs are prescribed and if they are being prescribed appropriately.

Objective: The study aimed to assess the appropriateness of PPIs use among hospitalized patients. It evaluated the indications for PPIs use and determined whether the use of PPIs in hospitalized patients is justified or not.

Setting: The study was conducted at Hamad General Hospital, a tertiary academic healthcare center in the state of Qatar.

Methods: A retrospective observational study with 201 subjects, was conducted in general internal medicine wards at a tertiary hospital. Physician documentation and inpatient and outpatient medication prescriptions were analyzed for PPIs exposure.

Main outcome measures: The appropriateness of exposure to PPIs is determined based on international recommendations.

Results: Of 533 hospitalized patients who were not critically ill, 201 (37.7%) were prescribed PPIs. The study found that 65.2% of the patients had no valid indication for PPIs exposure. Furthermore, 18% of patients were inappropriately prescribed stress ulcer prophylaxis with PPIs even though they had a low risk for the development of ulcer disease. After discharge, 82.6% of patients were prescribed PPIs, with the most common indication (43%) being gastrointestinal ulcer prophylaxis.

Conclusion: This study sheds light on the issue of overutilization of PPIs, specifically in non-critically ill hospitalized patients. It highlights the unnecessary continuation of PPI prescriptions at discharge and emphasizes the importance of physicians reevaluating PPI prescriptions periodically to ensure they are still necessary and discontinuing them when possible to avoid unwanted consequences.

© 2024 Karuppasamy, Yahia, Parambil, Ismail, Ibn-mas’ud Danjuma, Licensee HBKU Press.
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2024-11-11
2024-11-20
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References

  1. Lassalle M, Lassalle M, Tri TL, Bardou M, Biour M, Kirchgesner J, et al.. Use of proton pump inhibitors in adults in France: A nationwide drug utilization study. Eur J Clin Pharmacol. 2020; 76:(3):449–57. https://doi.org/10.1007/s00228-019-02810-1
     [Google Scholar]
  2. Othman F, Card TR, Crooks CJ. Proton pump inhibitor prescribing patterns in the UK: A primary care database study. Pharmacoepidemiol Drug Saf. 2016; 25:(9):1079–87. https://doi.org/10.1002/pds.4043
     [Google Scholar]
  3. Rückert-Eheberg I-M, et al.. Who gets prescriptions for proton pump inhibitors and why? A drug-utilization study with claims data in Bavaria, Germany, 2010–2018. Eur J Clin Pharmacol. 2022; 78:(4):657–67. https://doi.org/10.1007/s00228-021-03257-z
     [Google Scholar]
  4. Pham CQ, Regal RE, Bostwick TR, Knauf KS. Acid suppressive therapy use on an inpatient internal medicine service. Ann Pharmacother. 2006; 40:(7–8):1261–1266. https://doi.org/10.1345/aph.1g703
     [Google Scholar]
  5. Rauch J, Patrzyk M, Heidecke C-D, Schulze T. Current practice of stress ulcer prophylaxis in a surgical patient cohort in a German university hospital. Langenbecks Arch Surg. 2021; 406:(8):2849–59. https://doi.org/10.1007/s00423-021-02325-3
     [Google Scholar]
  6. Moriarty F, Cahir C, Bennett K, Fahey T. Economic impact of potentially inappropriate prescribing and related adverse events in older people: A cost-utility analysis using Markov models. BMJ Open. 2019; 9:(1):e021832. https://doi.org/10.1136/bmjopen-2018-021832
     [Google Scholar]
  7. 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:(2):122–9. https://doi.org/10.18553/jmcp.2010.16.2.122
     [Google Scholar]
  8. Fossmark R, Martinsen TC, Waldum HL. Adverse effects of proton pump inhibitors—Evidence and plausibility. Int J Mol Sci. 2019; 20:(20):5203. https://doi.org/10.3390/ijms20205203
     [Google Scholar]
  9. Jaynes M, Kumar AB. The risks of long-term use of proton pump inhibitors: A critical review. Ther Adv Drug Saf. 2019; 10:204209861880992. https://doi.org/10.1177/2042098618809927
     [Google Scholar]
  10. Poly TN, Islam MM, Yang HC, Wu CC, Li YC. Proton pump inhibitors and risk of hip fracture: A meta-analysis of observational studies. Osteoporos Int. 2019; 30:(1):103–14. https://doi.org/10.1007/s00198-018-4788-y
     [Google Scholar]
  11. Varma S, Trudeau SJ, Li J, Freedberg DE. Proton pump inhibitors and risk of enteric infection in inflammatory bowel disease: A self-controlled case series. Inflamm Bowel Dis. 2023; 30:(1):38–44. https://doi.org/10.1093/ibd/izad035
     [Google Scholar]
  12. U.S. Food and Drug Administration. Proton pump inhibitors: US Food and Drug Administration-approved indications and dosages for use in adults. Silver Spring:U.S. Food and Drug Administration; 2014. Available from: http://www.fda.gov/drugs
     [Google Scholar]
  13. Benmassaoud A, McDonald EG, Lee TC. Potential harms of proton pump inhibitor therapy: Rare adverse effects of commonly used drugs. Can Med Assoc J. 2016; 188:(9):657–62. https://doi.org/10.1503/cmaj.150570
     [Google Scholar]
  14. Scarpignato C, Gatta L, Zullo A, Blandizzi C. Effective and safe proton pump inhibitor therapy in acid-related diseases—A position paper addressing benefits and potential harms of acid suppression. BMC Med. 2016; 14:(1):179. https://doi.org/10.1186/s12916-016-0718-z
     [Google Scholar]
  15. Weijenborg PW, Cremonini F, Smout AJPM, Bredenoord AJ. PPI therapy is equally effective in well-defined non-erosive reflux disease and in reflux esophagitis: A meta-analysis. Neurogastroenterol Motil. 2012; 24:(8):747. https://doi.org/10.1111/j.1365-2982.2012.01888.x
     [Google Scholar]
  16. Hong MT, Monye LC, Seifert CF. Acid suppressive therapy for stress ulcer prophylaxis in noncritically Ill patients. Ann Pharmacother. 2015; 49:(9):1004–8. https://doi.org/10.1177/1060028015592014
     [Google Scholar]
  17. Grant CH, Gillis KA, Lees JS, Traynor JP, Mark PB, Stevens KI. Proton pump inhibitor use and progression to major adverse renal events: A competing risk analysis. QJM. 2019; 112:(11):835–40. https://doi.org/10.1093/qjmed/hcz166
     [Google Scholar]
  18. Mohamed MR, Itani M, Abohelwa M, Ahmed MA, Abdouni L, Doumat G, et al.. The silent epidemic: Inappropriate use of proton pump inhibitors among hospitalized patients. Arab J Gastroenterol. 2024. https://doi.org/10.1016/j.ajg.2024.07.001
     [Google Scholar]
  19. Clarke K, et al.. Reducing overuse of proton pump inhibitors for stress ulcer prophylaxis and nonvariceal gastrointestinal bleeding in the hospital: A narrative review and implementation guide. J Hosp Med. 2021; 16:(7):417–23. https://doi.org/10.12788/jhm.3637
     [Google Scholar]
  20. Liu P, Li G, Wu Q, Han M, Zhang C. Analysis of inappropriate prophylactic use of proton pump inhibitors during the perioperative period: An observational study. Perioper Med. 2024; 13:(1):19. https://doi.org/10.1186/s13741-024-00376-w
     [Google Scholar]
  21. Ali O, Poole R, Okon M, Maunick S, Troy E. Irrational use of proton pump inhibitors in general practise. Ir J Med Sci. 2019; 188:(2):541–544. https://doi.org/10.1007/s11845-018-1891-1
     [Google Scholar]
  22. Wohlt PD, Hansen LA, Fish JT. Inappropriate continuation of stress ulcer prophylactic therapy after discharge. Ann Pharmacother. 2007; 41:(10):1611–6. https://doi.org/10.1345/aph.1k227
     [Google Scholar]
  23. Winter JW, Sandle M, McLeod U, Grosset K. Whose proton pumps are we inhibiting? A study of PPI prescribing in primary care in east glasgow. Gut. 2011; 60:(Suppl. 1):A107–8. https://doi.org/10.1136/gut.2011.239301.225
     [Google Scholar]
  24. Freedberg DE, Kim LS, Yang Y-X. The risks and benefits of long-term use of proton pump inhibitors: Expert review and best practice advice from the American Gastroenterological Association. Gastroenterology. 2017; 152:(4):706–715. https://doi.org/10.1053/j.gastro.2017.01.031
     [Google Scholar]
  25. Targownik LE, Fisher DA, Saini SD. AGA clinical practice update on de-prescribing of proton pump inhibitors: Expert review. Gastroenterology. 2022Apr; 162:(4):1334–42. https://doi.org/10.1053/j.gastro.2021.12.247
     [Google Scholar]
/content/journals/10.5339/qmj.2024.60
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Proton pump inhibitors in inpatients: Are we getting it right? A retrospective analysis
Qatar Medical Journal 2024, 60 (2024); https://doi.org/10.5339/qmj.2024.60
/content/journals/10.5339/qmj.2024.60
/content/journals/10.5339/qmj.2024.60
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  • Article Type: Research Article
Keyword(s): acid-suppressive therapy, hypomagnesemia, Proton pump inhibitors and renal impairment

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