Over-utilization of intravenous proton pump inhibitor in non-intensive care unit patients

Proton pump inhibitors (PPIs) are the most effective agents for treating acid related gastrointestinal (GI) disorders. The utilization of intravenous (IV) formulations of PPIs has dramatically increased in health care institutions for inappropriate indications, route of administration and length of treatment. This is associated with an increased cost burden, increased risk of IV related infections, and utilization of hospital resources.

A research team from Lebanon assessed the clinical and cost impacts of PPI utilization in hospitalized patients. Their study was published on February 28, 2010 in the World Journal of Gastroenterology.

Their results illustrated that the majority of non-intensive care patients were receiving PPIs for claimed stress ulcer prophylaxis (SUP); of which, less than half met the guideline criteria for SUP indication or for Non-Steroidal-Anti-inflammatory Drugs (NSAIDs)-induced ulcer prophylaxis, while the remaining patients were identified as having an unjustified indication for PPI use. Regardless of the appropriateness of the initial intravenous route of administration, switching patients to the oral form when deemed appropriate was carried out in only one third of patients.

Furthermore, the cost analysis associated with the inappropriateness of the indication for PPI use as well as the route of administration of PPI revealed an unnecessary increase in cost.

The researchers highlighted the importance of implementing restrictions on the use of intravenous PPI in order to improve not only clinical impact but also cost impact.

Reference: Nasser SC, Nassif JG, Dimassi HI. Clinical and cost impact of intravenous proton pump inhibitor use in non-ICU patients. World J Gastroenterol 2010; 16(8): 982-986

http://www.wjgnet.com/1007-9327/16/982.asp

Correspondence to: Soumana C Nasser, Pharm. D, Clinical Assistant Professor, Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos Campus, PO Box 36, 13-5053 Beirut, Lebanon.

soumana.nasser@lau.edu.lb

Telephone: +961-3-489860 Fax: +961-9-547256

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H. pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2008 IF: 2.081. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.

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