Inappropriate utilization of intravenous proton pump inhibitors in hospital practice--a prospective study of the extent of the problem and predictive factors

Abstract

Background: Intravenous (IV) proton pump inhibitors (PPI) reduce rebleeding from high-risk peptic ulcers following endoscopic therapy. The majority of IV PPI prescriptions in US hospital practice are inappropriate, leading to unnecessary drug costs, drug shortages and potential adverse events. To date, little is known about UK hospital IV PPI prescribing practice.

Aims: To examine IV PPI use in a large university teaching hospital to determine factors predicting inappropriate prescribing practices.

Methods: Prospective study of 276 recently hospitalized patients initiated on IV PPI over a 6-month period. IV PPI use was deemed appropriate for the following indications: endoscopic evidence of recent upper gastrointestinal (UGI) haemorrhage, patient nil by mouth with a valid indication for oral PPI therapy and stress ulcer prophylaxis in a critical care setting.

Results: The majority (208/276, 75.4%) of IV PPI prescriptions were deemed inappropriate in terms of either indication for use, dose or duration of therapy. The majority (168/276, 60.9%) of prescriptions were initiated on non-medical wards. Inappropriate prescribing was more common amongst female patients, surgical admissions, non-UGI haemorrhage cases and when initiated by junior hospital doctors. Surgical admission [odds ratio (OR) 2.88, 95% confidence interval (CI) 1.12-7.42] and female gender [OR 3.92 (95% CI 1.84-8.34)] were independently predictive of inappropriate use.

Conclusion: This study suggests that the majority of IV PPI prescriptions in hospital are inappropriate, particularly when initiated for non-UGI bleeding indications. Improving prescribing awareness through education of junior medical staff on non-medical wards could reduce inappropriate IV PPI use.