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2000
Volume 20, Issue 1
  • ISSN: 1574-8863
  • E-ISSN: 2212-3911

Abstract

Background

There are concerns about indiscriminate prescriptions and the inappropriate use of proton pump inhibitors (PPIs) without any clear indications, especially among non-critically hospitalized patients.

Objective

This study aimed to characterize PPI prescriptions among non-critically hospitalized patients in a tertiary care hospital in Saudi Arabia.

Methods

A retrospective cross-sectional study was conducted at the King Abdulaziz University Hospital between June and August 2021. The data of adult patients who received PPIs on hospital admission in the medical and surgical wards were collected and analyzed for appropriateness based on the current international guidelines and recommendations.

Results

A total of 174 patient records were included in this study. The proportion of patients with appropriate and inappropriate PPI prescriptions was 67.24% (n=117) and 32.76% (n=57), respectively. Female patients (risk=50.00%, 95% CI: 36.89–63.11, p<0.001) were more likely to receive an inappropriate PPI prescription than their male counterparts (risk=33.33%, 95% CI: 24.56–43.43, p<0.001). Intravenous omeprazole 40 mg once daily was the most frequently prescribed PPI (n=62). The hospital length of stay differed significantly between the groups of patients who received appropriate and inappropriate PPIs (24.56 ± 47.14 13.50 ± 13.84; t=2.34, 95% CI: 1.72–20.4; p=0.02). However, there was no significant difference in the total therapy duration in both the groups (3.76 ± 2.50 4.75 ± 3.32, t=-1.62, 95%CI: -1.79–0.17; p=0.11).

Conclusion

The findings show a high trend of inappropriate PPI prescriptions. Hence, educational programs are recommended to encourage healthcare professionals to stick to the approved guidelines when prescribing PPIs.

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2025-04-06
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References

  1. StrandD.S. KimD. PeuraD.A. 25 Years of proton pump inhibitors: A comprehensive review.Gut Liver2017111273710.5009/gnl1550227840364
    [Google Scholar]
  2. SavarinoV. AntonioliL. FornaiM. MarabottoE. DemarzoM.G. ZingoneF. GhisaM. BarberioB. ZentilinP. RibolsiM. SavarinoE. An update of pharmacology, efficacy, and safety of vonoprazan in acid-related disorders.Expert Rev. Gastroenterol. Hepatol.202216540141010.1080/17474124.2021.198487834550866
    [Google Scholar]
  3. ScarpignatoC. GattaL. ZulloA. BlandizziC. Effective and safe proton pump inhibitor therapy in acid-related diseases - A position paper addressing benefits and potential harms of acid suppression.BMC Med.201614117910.1186/s12916‑016‑0718‑z27825371
    [Google Scholar]
  4. AhmedA. ClarkeJ.O. Proton Pump Inhibitors (PPI).In: StatPearls.Treasure Island, FLStatPearls Publishing2022
    [Google Scholar]
  5. KamadaT. SatohK. ItohT. ItoM. IwamotoJ. OkimotoT. KannoT. SugimotoM. ChibaT. NomuraS. MiedaM. HiraishiH. YoshinoJ. TakagiA. WatanabeS. KoikeK. Evidence-based clinical practice guidelines for peptic ulcer disease 2020.J. Gastroenterol.202156430332210.1007/s00535‑021‑01769‑033620586
    [Google Scholar]
  6. ClarkeK. AdlerN. AgrawalD. BhaktaD. SataS.S. SinghS. GuptaA. PahwaA. PhersonE. SunA. VolpicelliF. ChoH.J. Indications for the use of proton pump inhibitors for stress ulcer prophylaxis and peptic ulcer bleeding in hospitalized patients.Am. J. Med.2022135331331710.1016/j.amjmed.2021.09.01034655535
    [Google Scholar]
  7. ChaitM. Chait MermelsteinA. MermelsteinJ. Proton pump inhibitors for the treatment of patients with erosive esophagitis and gastroesophageal reflux disease: Current evidence and safety of dexlansoprazole.Clin. Exp. Gastroenterol.2016916317210.2147/CEG.S9160227471402
    [Google Scholar]
  8. ZerbibF. BredenoordA.J. FassR. KahrilasP.J. RomanS. SavarinoE. SifrimD. VaeziM. YadlapatiR. GyawaliC.P. ESNM/ANMS consensus paper: Diagnosis and management of refractory gastro‐esophageal reflux disease.Neurogastroenterol. Motil.2021334e1407510.1111/nmo.1407533368919
    [Google Scholar]
  9. LeeL. Ramos-AlvarezI. ItoT. JensenR.T. Insights into effects/risks of chronic hypergastrinemia and lifelong PPI treatment in man based on studies of patients with zollinge-ellison syndrome.Int. J. Mol. Sci.20192020512810.3390/ijms2020512831623145
    [Google Scholar]
  10. Pinto-SanchezM.I. YuanY. HassanA. BercikP. MoayyediP. Proton pump inhibitors for functional dyspepsia.Cochrane Libr.201720183CD01119410.1002/14651858.CD011194.pub329161458
    [Google Scholar]
  11. ChauS.H. SluiterR.L. HugtenburgJ.G. WensingM. KievitW. TeichertM. Cost-utility and budget impact analysis for stopping the inappropriate use of proton pump inhibitors after cessation of NSAID or Low-dose acetylsalicylic acid treatment.Drugs Aging2020371677410.1007/s40266‑019‑00713‑531560115
    [Google Scholar]
  12. IerardiE. LosurdoG. FortezzaR.F.L. PrincipiM. BaroneM. LeoA.D. Optimizing proton pump inhibitors in Helicobacter pylori treatment: Old and new tricks to improve effectiveness.World J. Gastroenterol.201925345097510410.3748/wjg.v25.i34.509731558859
    [Google Scholar]
  13. LinD. EkeC. CaiC. ThriftA.P. ShuklaR. Decreasing overall and inappropriate proton pump inhibitor use: Perspective from a large safety-net healthcare system.Clin. Gastroenterol. Hepatol.2020184763766.e210.1016/j.cgh.2019.12.01531887439
    [Google Scholar]
  14. Mat SaadA.Z. CollinsN. LoboM.M. O’ConnorH.J. Proton pump inhibitors: A survey of prescribing in an Irish general hospital.Int. J. Clin. Pract.2005591313410.1111/j.1742‑1241.2004.00298.x15707461
    [Google Scholar]
  15. NauntonM. PetersonG.M. BleaselM.D. Overuse of proton pump inhibitors.J. Clin. Pharm. Ther.200025533334010.1046/j.1365‑2710.2000.00312.x11123484
    [Google Scholar]
  16. WalkerN.M. McDonaldJ. An evaluation of the use of proton pump inhibitors.Pharm. World Sci.200123311611710.1023/A:101127803000111468876
    [Google Scholar]
  17. BustillosH. LeerK. KittenA. RevelesK.R. A cross-sectional study of national outpatient gastric acid suppressant prescribing in the United States between 2009 and 2015.PLoS One20181311e020846110.1371/journal.pone.020846130500865
    [Google Scholar]
  18. LiuY. ZhuX. LiR. ZhangJ. ZhangF. Proton pump inhibitor utilisation and potentially inappropriate prescribing analysis: Insights from a single-centred retrospective study.BMJ Open20201011e04047310.1136/bmjopen‑2020‑04047333243802
    [Google Scholar]
  19. ÇelikF. AypakC. ÖzdemirA. GörpelioğluS. Inappropriate prescribing of proton pump inhibitors in outpatient clinics.Gastroenterol. Nurs.2021442849110.1097/SGA.000000000000050033795619
    [Google Scholar]
  20. LaheijR.J.F. SturkenboomM.C.J.M. HassingR-J. DielemanJ. StrickerB.H.C. JansenJ.B.M.J. Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs.JAMA2004292161955196010.1001/jama.292.16.195515507580
    [Google Scholar]
  21. AlmirallJ. Serra-PratM. BolíbarI. BalassoV. Risk factors for community-acquired pneumonia in adults: A systematic review of observational studies.Respiration201794329931110.1159/00047908928738364
    [Google Scholar]
  22. DialS. DelaneyJ.A.C. BarkunA.N. SuissaS. Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease.JAMA2005294232989299510.1001/jama.294.23.298916414946
    [Google Scholar]
  23. YangY.X. LewisJ.D. EpsteinS. MetzD.C. Long-term proton pump inhibitor therapy and risk of hip fracture.JAMA2006296242947295310.1001/jama.296.24.294717190895
    [Google Scholar]
  24. ReedL.G. MokJ.Y. Proton pump inhibitor-associated hypomagnesemia: A retrospective case-control study.Fed. Pract.20163312182130766152
    [Google Scholar]
  25. CharlotM. GroveE.L. HansenP.R. OlesenJ.B. AhlehoffO. SelmerC. LindhardsenJ. MadsenJ.K. KøberL. Torp-PedersenC. GislasonG.H. Proton pump inhibitor use and risk of adverse cardiovascular events in aspirin treated patients with first time myocardial infarction: Nationwide propensity score matched study.BMJ2011342may11 1d269010.1136/bmj.d269021562004
    [Google Scholar]
  26. ZhaiY. YeX. HuF. XuJ. GuoX. LinZ. ZhouX. GuoZ. CaoY. HeJ. Updated insights on cardiac and vascular risks of proton pump inhibitors: A real-world pharmacovigilance study.Front. Cardiovasc. Med.2022976798710.3389/fcvm.2022.76798735282344
    [Google Scholar]
  27. LazarusB. ChenY. WilsonF.P. SangY. ChangA.R. CoreshJ. GramsM.E. Proton pump inhibitor use and the risk of chronic kidney disease.JAMA Intern. Med.2016176223824610.1001/jamainternmed.2015.719326752337
    [Google Scholar]
  28. MillerJ.W. Proton pump inhibitors, h2-receptor antagonists, metformin, and vitamin b-12 deficiency: Clinical implications.Adv. Nutr.201894511S518S10.1093/advances/nmy02330032223
    [Google Scholar]
  29. NICEGastro-oesophageal reflux disease and dyspepsia in adults: Investigation and management.2014Available from:https://www.nice.org.uk/guidance/cg184 (Accessed: September 4, 2022).
  30. FDADrugs@FDA: FDA-Approved Drugs.2017Available from:https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=210070 (Accessed: September 4, 2022).
  31. HongJ. WheltonH. DouglasG. KangJ. Consumption frequency of added sugars and UK children’s dental caries.Community Dent. Oral Epidemiol.201846545746410.1111/cdoe.1241330125961
    [Google Scholar]
  32. KellyO.B. DillaneC. PatchettS.E. HarewoodG.C. MurrayF.E. The inappropriate prescription of oral proton pump inhibitors in the hospital setting: A prospective cross-sectional study.Dig. Dis. Sci.20156082280228610.1007/s10620‑015‑3642‑825840918
    [Google Scholar]
  33. FagianoR. FalconeY. FonteG. CenaC. BrunettiE. BoM. Indications, appropriateness and drug interactions of proton pump inhibitors prescribed at hospital discharge in older medical patients.Geriatr. Gerontol. Int.20171781238124010.1111/ggi.1304328849627
    [Google Scholar]
  34. AssimonM.M. PunP.H. Al-KhatibS.M. BrookhartM.A. GaynesB.N. WinkelmayerW.C. FlytheJ.E. Proton pump inhibitors may enhance the risk of citalopram‐ and escitalopram‐associated sudden cardiac death among patients receiving hemodialysis.Pharmacoepidemiol. Drug Saf.202231667067910.1002/pds.542835285107
    [Google Scholar]
  35. LinS.F. LinP.C. ChangC.C. ChangW.L. ChuF.Y. Investigation of the interaction between proton pump inhibitors and clopidogrel using VerifyNow P2Y12 assay.Medicine20209950e2369510.1097/MD.000000000002369533327360
    [Google Scholar]
  36. YoungP.J. BagshawS.M. ForbesA.B. NicholA.D. WrightS.E. BaileyM. BellomoR. BeasleyR. BrickellK. EastwoodG.M. GattasD.J. van HarenF. LittonE. MackleD.M. McArthurC.J. McGuinnessS.P. MounceyP.R. NavarraL. OpgenorthD. PilcherD. SaxenaM.K. WebbS.A. WileyD. RowanK.M. Effect of stress ulcer prophylaxis with proton pump inhibitors vs histamine-2 receptor blockers on in-hospital mortality among ICU patients receiving invasive mechanical ventilation.JAMA2020323761662610.1001/jama.2019.2219031950977
    [Google Scholar]
  37. YingJ. LiL.C. WuC.Y. YuZ.W. KanL.D. The status of proton pump inhibitor use: A prescription survey of 45 hospitals in China.Rev. Esp. Enferm. Dig.20191111073874310.17235/reed.2019.6155/201931373505
    [Google Scholar]
  38. DamjiS.S. RabbaniS.A. RaoP.G.M. ButtA.R. Proton pump inhibitor use and appropriateness analysis: A snapshot from a secondary care hospital.J. Pharm. Health Serv. Res.202112220621210.1093/jphsr/rmab013
    [Google Scholar]
  39. OrelioC.C. HeusP. Kroese-van DierenJ.J. SpijkerR. van MunsterB.C. HooftL. Reducing inappropriate proton pump inhibitors use for stress ulcer prophylaxis in hospitalized patients: Systematic review of de-implementation studies.J. Gen. Intern. Med.20213672065207310.1007/s11606‑020‑06425‑633532958
    [Google Scholar]
  40. DurandC. WillettK.C. DesiletsA.R. Proton pump inhibitor use in hospitalized patients: Is overutilization becoming a problem?Clin. Med. Insights Gastroenterol.20125CGast.S958810.4137/CGast.S958824833936
    [Google Scholar]
  41. WahkingR.A. SteeleR.L. HannersR.E. LockwoodS.M. DavisK.W. Outcomes from a pharmacist - led proton pump inhibitor stewardship program at a single institution.Hosp. Pharm.2018531596710.1177/001857871774719229434389
    [Google Scholar]
  42. MehtaN. Martinez GuaschF. KamenC. ShahS. BurryL.D. SoongC. MehtaS. Proton pump inhibitors in the elderly hospitalized patient: Evaluating appropriate use and deprescribing.J. Pharm. Technol.2020362546010.1177/875512251989495334752519
    [Google Scholar]
  43. NachnaniJ.S. BulchandaniD. MoormeierJ. FoxworthJ. Patient and physician predictors of inappropriate acid‐suppressive therapy (AST) use in hospitalized patients.J. Hosp. Med.200948E10E1410.1002/jhm.49219827047
    [Google Scholar]
  44. BarlettaJ.F. SclarD.A. Use of proton pump inhibitors for the provision of stress ulcer prophylaxis: clinical and economic consequences.PharmacoEconomics201432151310.1007/s40273‑013‑0119‑524271943
    [Google Scholar]
  45. HammondD.A. KatheN. ShahA. MartinB.C. Cost‐effectiveness of histamine 2 receptor antagonists versus proton pump inhibitors for stress ulcer prophylaxis in critically Ill patients.Pharmacotherapy2017371435310.1002/phar.185927809338
    [Google Scholar]
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  • Article Type:
    Research Article
Keyword(s): appropriateness; GERD; NSAIDs; prescription; Proton pump inhibitors; ulcer prophylaxis
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