Indication of acid suppression therapy and predictors for the prophylactic use of proton-pump inhibitors vs. histamine-2 receptor antagonists in a Malaysian tertiary hospital

Abstract

Background:Proton-pump inhibitors (PPI) and histamine-2 receptor antagonists (H2RA) are common acid suppressants used in gastrointestinal disorders. The trend of usage in Malaysia has changed from predominantly H2RA to PPI from 2007 to 2008, 3.46 versus 2.87 and 2.99 versus 3.24 DDD (Defined Daily Dose)/1000 population/day respectively. This raises concerns as PPI overutilization amounts to higher cost expenditure and are associated with various untoward consequences such as Clostridium difficile-associated diarrhea, pneumonia, and osteoporosis.Objectives:To evaluate the indication of acid suppression therapy (AST) and to look for predictors associated with the prophylactic use of PPI as compared to H2RA.Methods:Data collection was conducted via a standardized surveillance form over a 2-month period in the general medical wards of Sarawak General Hospital. All patients who received at least one dose of PPI or H2RA in any dosage form were included in the study. Appropriateness of prophylaxis was determined using current available guidelines. Selected risk factors were analysed using simple logistic regression to look for predictors associated with the choice of PPI in prophylactic AST.Results:Out of 212 cases in the present cohort, about three quarters (75.5%, n=160) of acid suppressants were given as prophylaxis. Over half of these did not have appropriate indications for prophylactic AST (58.1%, n=93). Among all cases given prophylactic AST, 75.0% (n=120) of them were given PPI. Renal insufficiency was identified as the only predictor associated with the use of prophylactic PPI in preference to H2RA (OR=2.86, 95%CI 1.21:6.72, p=0.011).Conclusion:Inappropriate prophylactic AST is a major concern and may even be underestimated due to the lack of appropriate guidelines. More data is required to guide the selection between PPI and H2RA, specifically the more cost-effective use of H2RA in patients with lower gastrointestinal risk or in whom PPI has no clear advantage.

Evaluation of the prescribing of proton pump inhibitors as stress ulcer prophylaxis for non-ICU patients in a Malaysian tertiary hospital

“…Evaluation of the prescribing of proton pump inhibitors as stress ulcer prophylaxis for non-ICU patients in a Malaysian tertiary hospit… https://link.springer.com/article/10.1007/s40267-020-00770- 6 5/13 We use cookies to personalise content and ads, to provide social media features and to analyse our traffic. We also share information about your use of our site with our social media, advertising and analytics partners in accordance with our Privacy Statement.…”

“…prescribing of proton pump inhibitors as stress ulcer prophylaxis for non-ICU patients in a Malaysian tertiary hospit… https://link.springer.com/article/10.1007/s40267-020-00770-6 6/13…”

Pharmacotherapy Evaluation and Utilization in Coronary Artery Bypass Grafting Patients in Kosovo during the Period 2016-2017

“…Also, the antiacids such as IPP or H2 blockers are mainly used as prophylaxis regarding the surgical intervention which is a common indication [ 45 ] and decreases in the visit after the operation. Other drugs such as analgesics including acetaminophen are indicated as needed mostly in postoperative period with nonsteroidal anti-inflammatory drugs indomethacin, acetylcysteine dominated in the period after the operation and reduced in the visit after operation with also cephalosporin antibiotics.…”

Non‐indicated acid‐suppression prescribing in a tertiary paediatric hospital: An audit and costing study

“…In our study, children receiving AST without primary indication whilst also potentially on steroids may have been placed on acid suppression prophylactically. High rates of inappropriate prophylactic acid suppression, mainly in adults, have been found across Malaysia, Europe and the USA Data suggest that routine acid‐suppression ‘prophylaxis’ for corticosteroids alone, particularly amongst outpatients, is unnecessary . More paediatric data are required to understand the relative risks to these patients.…”