Appropriateness of the use of proton pump inhibitors in the Emergency Department of a Spanish university hospital

Abstract

Background: the use of proton pump inhibitors (PPI) has increased substantially during the last years, possibly due to a significant proportion of prescriptions that do not follow the approved indications. Objective: to assess the prevalence of PPI prescription and the appropriateness of the prescription within the Emergency Department (ED) of a Spanish university hospital. Materials and methods: a cross-sectional, retrospective prescription-indication drug-use study was performed, which selected 384 patients that presented to the ED over two days in January 2016. Results: of the total cohort, 23.2% were taking PPI before their hospital visit and only 20.2% had a correct indication and dosage; 2.9% of the patient cohort had an indication for PPI treatment but had not been prescribed them. A drug other than omeprazole was used in 25% of cases; 30.47% of the patients were discharged with a PPI and only 28.2% of them had the correct indication and dosage. Finally, 5.7% were not prescribed PPI even though it was warranted. PPI prescription increased with age whereas the indication for the prescription decreased. Furthermore, the use of these drugs was higher in hospitalized patients compared to discharged patients. Conclusions: these results are in line with similar studies, which demonstrate the existence of an over-prescription of PPI. PPI prescription needs to be improved, thereby reducing drug interactions, adverse effects and unnecessary economical expenses.

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

“…First, it is important to regularly reassess the need for ongoing treatment with PPI and how the risks can be reduced when prescribing PPI. Second, PPI over-use should be controlled by limiting the appropriateness of reimbursement, over-prescription and improving the distribution of therapeutic recommendation guidelines (27). Third, more studies should define the appropriate indications of PPI use, investigate the exact causality between risk and PPI use and also develop alternate management options for acid peptic diseases (24,28).…”

“…Inappropriate PPI use and the associated risks have dramatically increased over the last few decades (2,(4)(5)(6). Emerging post-marketing studies have demonstrated that inappropriate PPI use has become a major clinical problem (2,7,8). Several case-control, cohort and meta-analyses studies have reported that PPI use increased the risk of various adverse effects including kidney disease (9)(10)(11)(12)(13)(14)(15)(16)(17).…”