Snapshot of proton pump inhibitors prescriptions in a tertiary care hospital in Switzerland: less is more?

Abstract

Background Proton pump inhibitors are among the most widely prescribed drugs in the world, but more than half of the indications for prescription are unjustified. The misuse of this therapeutic class has heavy consequences such as additional health costs, adverse drug reactions following long-term use and gastric acid rebound when the proton pump inhibitor is discontinued. Objective The overprescription of proton pump inhibitors is therefore becoming a public health problem, which led us to evaluate their use within the Geneva University Hospitals. Setting Patients hospitalized in two divisions of the department of internal medicine of the Geneva University Hospitals on a single day. Methods This is a register-based cross-sectional study and it collected data about the prescription pattern of proton pump inhibitors by consulting the electronic records of patients included. Main outcome measure To determine if the proton pump inhibitors prescription is made according to the market authorization and the available guidelines. Results Hundred-eighty patients were included. 54% of patients were on proton pump inhibitors, 29% of whom had their treatment initiated at hospital. Of the indications for treatment, 72% were not justified and 63% of the justified indications did not have an adequate dosage. Therefore, in all patients with a proton pump inhibitor at hospital, only 11% had a justified indication with an adequate dose. Finally, 87% of known home prescriptions were renewed on admission and among them, 71% did not have a justified or possibly justified indication according to the guidelines. Conclusion Indication for treatment inside the hospital was not justified in 72% of patients and only 11% had a justified indication with an adequate dosage. Precise guidelines with evidence-based indications and adequate daily doses would help to correctly prescribe proton pump inhibitors. Moreover, patients should benefit from a thorough evaluation of their treatment. Impact of findings on practice statements• Around 70% of the renewed prescriptions for proton pump inhibitors on admission did not have a justified indication. • As many as 72% of the hospitalised patients had an unjustified indication for a proton pump inhibitor.

Impact of interventions targeting the inappropriate use of proton‐pump inhibitors by clinical pharmacists in a hepatobiliary surgery department

“…Proton‐pump inhibitors (PPIs) are widely used to treat and prevent multiple gastric acid‐related diseases 1,2 . PPI usage has grown over time in China and other countries 3‐12 . Given their increasing use, the risks of PPIs and the problem of overuse have attracted the attention of physicians and industry.…”

Новая Группа Антисекреторных Средств — Калий-Конкурентные Ингибиторы Протонового Насоса

“… íàñòîÿùåå âðåìÿ ïðè ãèïåðàöèäíûõ ñîñòîÿíèÿõ ïðåïàðàòàìè âûáîðà ÿâëÿþòñÿ èíãèáèòîðû ïðîòîíîâîãî íàñîñà (ÈÏÍ). ÈÏÍ -îäíè èç ñàìûõ ïîïóëÿðíûõ ëåêàðñòâåííûõ ñðåäñòâ â ìèðå, ÷òî ïîäòâåðaeäàåòñÿ êî-ëè÷åñòâîì ðåöåïòîâ íà ÈÏÍ è îáúåìîì ïðîäàae [16,17]. ÈÏÍ ïðèìåíÿþò â êëèíè÷åñêîé ïðàêòèêå áîëåå 30 ëåò è, â îòëè÷èå îò àíòàãîíèñòîâ ãèñòàìèíîâûõ ðåöåïòîðîâ, ñèíòåòè÷åñêèõ àíàëîãîâ ïðîñòàãëàíäèíà Å 1 è ì-õîëèíîáëîêàòîðîâ, îêàçûâàþò áîëåå âûðàaeåííûé àíòèñåêðåòîðíûé ýôôåêò, à òàêaeå îáëàäàþò ëó÷øåé ïåðåíîñèìîñòüþ è áåçîïàñíîñòüþ [18].…”

“…ÈÏÍ íåîáîñíîâàííî íàçíà÷àþò ïàöèåíòàì áîëåå ÷åì â 60 % ñëó÷àåâ, ÷àùå âñåãî èç-çà òîãî, ÷òî áîëüøèíñòâî âðà÷åé âîñïðèíèìàþò ýòè ëåêàðñòâåííûå ñðåäñòâà êàê áåçîïàñíûå, ýôôåêòèâíûå ïðàêòè÷åñêè ïðè ëþáûõ ïðîáëåìàõ ñ ïèùåâàðåíèåì [15,16,22]. Ñàìûì ÷àñòûì ñëó÷àåì, ñâÿçàííûì ñ íåíàäëåaeàùèì íàçíà÷åíèåì ÈÏÍ, ÿâëÿåòñÿ íåîáîñíîâàííàÿ è/èëè íå-îãðàíè÷åííàÿ ïî âðåìåíè ïðîäîëaeèòåëüíîñòü òåðàïèè ÈÏÍ ïîñëå âûïèñêè èç ñòàöèîíàðà [22].…”

“…Ê íèì îòíîñÿòñÿ: ãè-ïåðòðîôèÿ è ãèïåðïëàçèÿ ïàðèåòàëüíûõ êëåòîê aeåëóäêà, ãèïåðãàñòðèíåìèÿ, ôîðìèðîâàíèå ïîëèïîâ aeåëóäêà, ñèíäðîì îòìåíû, îñòåîïîðîç è ïîâûøåíèå ðèñêà ïåðåëîìîâ êîñòåé (áåäðà, çàïÿñòüÿ, ïîçâîíî÷íèêà) ó ïàöèåíòîâ ñ äðóãèìè ôàêòîðàìè ðèñêà (èç-çà óìåíüøåíèÿ óñâîåíèÿ êàëüöèÿ, ìàãíèÿ è âèòàìèíà  12 èç-çà óìåíüøåíèÿ êèñëîòíîñòè) ïðè ïðèìåíåíèè ëåêàðñòâåííûõ ñðåäñòâ â âûñîêîé äîçå èëè â òå÷åíèå äëèòåëüíîãî âðåìåíè, ãèïîìàãíèåìèÿ, aeåëåçîäåôèöèòíàÿ è  12 äåôèöèòíàÿ àíåìèÿ, îñòðûé èíòåðñòèöèàëüíûé íåôðèò, õðîíè÷åñêàÿ ïî÷å÷íàÿ íåäîñòàòî÷íîñòü, óâåëè÷åíèå ðèñêà ðàçâèòèÿ âíóòðè-è âíåáîëü-íè÷íîé ïíåâìîíèè (ïðåèìóùåñòâåííî â ïåðâóþ íåäåëþ èñïîëüçîâàíèÿ ÈÏÍ), ñèíäðîì èçáûòî÷íîãî áàêòåðèàëüíîãî ðîñòà â òîíêîì êèøå÷íèêå, ïîâûøåíèå ðèñêà èíôåêöèé êèøå÷íèêà, âûçâàííûõ Salmonella spp., Campylobacter jejuni è Clostridium difficile, äèàðåÿ ïóòåøåñòâåííèêà (âûçâàííàÿ Escherichia coli èëè Shigella spp. ), ñïîíòàííûé áàêòåðèàëüíûé ïåðèòî-íèò [15,16,17,24,26]. Êðîìå òîãî, âûÿâëåíî íàëè÷èå ïðÿìîé ñâÿçè ìåaeäó ïðèìåíåíèåì ÈÏÍ è ðèñêîì ðàçâèòèÿ êîãíèòèâíûõ íàðóøåíèé è äåìåíöèè (èç-çà íàðóøåíèÿ ìîçãîâîãî êðîâîîáðàùåíèÿ, íåäîñòàòêà  12 è íàêîïëåíèÿ b-àìèëîèäà â òêàíè ìîçãà), à òàêaeå ðàçâèòèåì èøåìè÷åñêîãî èíñóëüòà, îñòðîãî êîðîíàðíîãî ñèíäðîìà (âñëåäñòâèå ýíäîòåëèàëüíîé äèñôóíêöèè è àòåðîñêëåðîòè÷åñêèõ èçìåíåíèé, âûçâàííûõ ïðèåìîì ÈÏÍ) [10,16,17,18,22,25].…”

“…), ñïîíòàííûé áàêòåðèàëüíûé ïåðèòî-íèò [15,16,17,24,26]. Êðîìå òîãî, âûÿâëåíî íàëè÷èå ïðÿìîé ñâÿçè ìåaeäó ïðèìåíåíèåì ÈÏÍ è ðèñêîì ðàçâèòèÿ êîãíèòèâíûõ íàðóøåíèé è äåìåíöèè (èç-çà íàðóøåíèÿ ìîçãîâîãî êðîâîîáðàùåíèÿ, íåäîñòàòêà  12 è íàêîïëåíèÿ b-àìèëîèäà â òêàíè ìîçãà), à òàêaeå ðàçâèòèåì èøåìè÷åñêîãî èíñóëüòà, îñòðîãî êîðîíàðíîãî ñèíäðîìà (âñëåäñòâèå ýíäîòåëèàëüíîé äèñôóíêöèè è àòåðîñêëåðîòè÷åñêèõ èçìåíåíèé, âûçâàííûõ ïðèåìîì ÈÏÍ) [10,16,17,18,22,25].…”