Non-guideline-recommended prescribing of proton pump inhibitors: implications for the future and reducing over usage

Abstract

Drs Godman and Fadare review the paper by Mares-Garcia and colleagues in Spain regarding the extent of non-guideline recommended prescribing (NGRP) of proton pump inhibitors (PPIs) in ambulatory care. NGRP of PPIs is an increasing public health concern given the implications of overuse of PPIs on infection rates, osteoporosis and chronic kidney disease as well as increasing polypharmacy rates. Costs are less of an issue especially where there are low prices for generic PPIs; the main focus is on improving the quality of PPI prescribing. Encouragingly, Mares-Garcia and colleagues identified key factors associated with NGRP, providing direction to others.

Ongoing activities to influence the prescribing of proton pump inhibitors within the Scottish National Health Service: their effect and implications

“…However, there are concerns that long term use of PPIs can have patient safety issues (1,26). Safety concerns include increasing the rate of community acquired pneumonia, increasing the number of fragility fractures, as well as increasing the number of clostridium difficile infections (CDI) possibly due to changes in the gut microbiomes.…”

Key Considerations From a Health Authority Perspective When Proton Pump Inhibitors Are Used to Treat Gastroesophageal Reflux Disease (GERD) and Their Implications

“…Other factors increasing PPI use include their increased prescribing as prophylaxis for elderly patients with arthritis as well as those on multiple medications. In addition, patients are being prescribed PPIs alongside anticoagulant therapy to reduce potential GI bleeding and avoidable hospital admissions [83,[118][119][120][121]. However, these combined factors have resulted in the potential overuse of PPIs leading to possible complications [83,117,118].…”

“…In addition, patients are being prescribed PPIs alongside anticoagulant therapy to reduce potential GI bleeding and avoidable hospital admissions [83,[118][119][120][121]. However, these combined factors have resulted in the potential overuse of PPIs leading to possible complications [83,117,118]. Mares-Garcia et al found that over a third of patients over the age of 60 years had no obvious reason for being prescribed a PPI [116], which needs to be addressed.…”