Pattern of intravenous proton pump inhibitors use in ICU and Non-ICU setting: a prospective observational study

ABSTRACT

The use of intravenous acid-suppressive therapy for stress ulcer prophylaxis in critically ill patients with specific risk factors has been recommended for over a decade. However, there is a lack of supporting data regarding the extension of such therapy to non-critically ill patients [non-ICU]. The aim of this study was to compare appropriate indications with current practicing patterns in adult non-ICU and ICU patients, contributing factors and financial impact of inappropriate use. A prospective cross-sectional study was carried out at a tertiary teaching Hospital in Riyadh, Saudi Arabia. For a period of 4 consecutive months, all hospitalized patients on IV PPI, aged 18 and above, were identified. A concise listing of indications considered appropriate for the use of IV PPI was pre-defined based on material from available literature and guidelines. A total of 255 patients received IV PPI. Inappropriate use of IV PPI was significantly higher in non-ICU [71.7%] than in ICU [19.8%] patients [P=0.01]. The most common cause for inappropriate use in non-ICU patients was stress ulcer prophylaxis [SUP]. In ICU patients, appropriate indicators for IV PPI were SUP [47.9%], PUD [11.5%], and the UGIB [20.8%]. There was a high association between appropriate uses of IV PPI with respect to endoscopic procedure and also between appropriate uses of IV PPI to subsequent discharge with oral PPI in non-ICU patients. The total estimated direct cost [drug acquisition cost] for inappropriate use of IV PPI during the study period was 11,000 US dollars. Inappropriate IV PPI utilization was predominant in non-ICU patients, mostly for stress ulcer prophylaxis that leads to a waste of resources. Applying appropriate policies, procedures and evidence-based guidelines, educated physicians and surgeons can clearly limit inappropriate IV PPI use