Evaluation of proton pump inhibitor administration in hospitalized dogs in a tertiary referral hospital

Abstract

Background Although proton pump inhibitors (PPIs) are commonly administered to hospitalized dogs, prescribing patterns and appropriateness of use require continued investigation. Hypothesis/Objective Describe prescription patterns and appropriateness of use associated with PPIs in hospitalized dogs at a single tertiary care facility. We hypothesized that the majority of prescriptions would not comply with current guidelines for the rational use of acid suppressants. Animals Two hundred randomly selected hospitalized dogs. Methods Retrospective evaluation of the medical records associated with a randomly selected sample of hospitalized dogs that received PPIs between January 2013 and December 2018. Results A total of 12 610 dogs were admitted for first‐time hospitalization between January 2013 and December 2018. Forty percent of these dogs (5062/12610) were prescribed a PPI PO or IV. Of the 200 randomly selected records, an adequate indication for use was identified in 27% of dogs (54/200). Of the dogs surviving to discharge, 54% (95/175) were discharged with a PPI and 51.6% (49/95) of those were prescribed an inadequate dose. Conclusions and Importance Our findings support other studies in which the majority of PPI prescriptions for hospitalized dogs at a tertiary care hospital lacked an appropriate indication. Furthermore, analysis of the prescribing patterns of dispensed PPIs identified a frequent occurrence of dosages considered inadequate, raising concern for ineffective treatment even with appropriate indications of use. With growing concern of adverse effects associated with PPI and other acid suppressant administration in human and veterinary medicine, rational use of these medications following consensus guidelines should be emphasized and treatment should be reserved for dogs with historical, physical examination, clinicopathologic, and imaging findings supportive of an appropriate indication for use.

Evaluation of a long‐acting injectable formulation of omeprazole in healthy dogs

“… 16 The PPIs and other gastroprotectants are often used inappropriately and overprescribed by general practitioners and veterinary specialists. 17 , 18 , 19 The authors advise judicious use of this medication for dogs where severe GI bleeding, treatment compliance, or both is a concern.…”

“…Although these potential benefits still need to be investigated in clinical cases, it is important to note that LA‐OMEP should only be used in dogs with a clear indication for gastric acid suppression, utilizing the guidelines established by the American College of Veterinary Internal Medicine Consensus Statement on the rational use of gastroprotectants 16 . The PPIs and other gastroprotectants are often used inappropriately and overprescribed by general practitioners and veterinary specialists 17‐19 . The authors advise judicious use of this medication for dogs where severe GI bleeding, treatment compliance, or both is a concern.…”

“…The authors decided to use the epaxial muscle bed as the injection site due to ease of observing injection site reactions with minimal disruption of the dogs. However, 1 study demonstrated that the fastest absorption of dexmedetomidine and hydromorphone was achieved after injection into the semimembranosus muscle 19 . It is difficult to say if absorption pharmacokinetics will be similar for LA‐OMEP, however an average onset of action of 98.11 minutes is still timely for most critically ill dogs with GI bleeding or moderate to severe esophagitis.…”

Evaluation of gastroprotectant administration in hospitalized cats in a tertiary referral hospital

“…Gastroprotectant medications, particularly acid suppressants such as proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs), are widely prescribed in human and small animal veterinary medicine to prevent and treat acid-related esophageal and gastrointestinal (GI) mucosal injury. [1][2][3][4][5][6][7][8][9][10] Frequent use in humans and animals has led to growing concerns of overutilization and inappropriate prescriptions of gastroprotectants. 1,[7][8][9][10][11][12][13][14] In humans, excessive acid suppressant prescription 1,[14][15][16] has resulted in an excess expenditure on PPIs of nearly $10 billion per year in the USA 17 and increased recognition of adverse effects associated with chronic, prolonged use of PPIs, such as micronutrient deficiencies, small intestinal bacterial overgrowth, pneumonia, osteoporosis, dementia and chronic renal insufficiency.…”

Effect of esomeprazole with and without a probiotic on fecal dysbiosis, intestinal inflammation, and fecal short‐chain fatty acid concentrations in healthy dogs

“…While it is known that PPIs can alter the gastrointestinal microbiome, it remains unknown if these changes are associated with clinical manifestations such as diarrhea. Regardless, the widespread use of PPIs in veterinary medicine indicates that interventions to help attenuate their adverse effects are needed 11 . Modulation of the microbiome with probiotics improves gut barrier function and reduces small intestinal bacterial overgrowth and intestinal inflammation in people receiving PPIs 12‐14 .…”