Inappropriate use of intravenous proton pump inhibitors is prevalent.
Dr Barkun and colleagues from Canada assessed appropriateness of intravenous proton pump inhibitor (PPI) prescribing.
The doctors conducted a retrospective review of in-patient prescribing of intravenous pantoprazole over a 2-month period in 2004, in an academic centre.
Prescribing was deemed appropriate before and after endoscopic hemostasis, and in fasting individuals requiring a proton pump inhibitor.
The team of doctors found that amongst 107 patients, 49 had upper gastrointestinal bleeding.
|Therapy was appropriate in 22% with non-upper GI bleeding|
|Alimentary Pharmacology & Therapeutics|
Overall, 31% received appropriate therapy, and 57% had an inappropriate indication.
The doctors observed that 12% had an incorrect treatment dose or duration.
Therapy was appropriate in 41% with upper gastrointestinal bleeding, and 22% in the non-upper gastrointestinal bleeding group.
Appropriate prescribing rates decreased from 41% to 16% when considering intravenous proton pump inhibitor use while awaiting endoscopy.
The team found that significant predictors of inappropriate use were increasing age and decreasing mean daily dose.
The doctors noted a trend for prescriptions written during evening shifts.
Dr Barkun's team concludes, “Inappropriate intravenous proton pump inhibitor utilization was most frequent in the non-upper gastrointestinal bleeding group, mostly for unrecognized indications.”
“Educational interventions to optimize utilization should target prescribing in older patients, those receiving lower mean daily doses, and, perhaps, prescribing outside regular hours.”