A Pragmatic Assessment of Proton‐Pump Inhibitors vs. Histamine Type 2 Receptor Antagonists on Clinically Important Gastrointestinal Bleeding and Mortality When Used for Stress Ulcer Prophylaxis in the ICU

An evaluation of a recent study by MacLaren R, Reynolds PM, Allen RR et al: Histamine-2 receptor antagonists vs proton pump inhibitors on gastrointestinal tract hemorrhage and infectious complications in the intensive care unit. JAMA Intern Med 2014, 174:564-574.

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Proton Pump Inhibitors Versus Histamine 2 Receptor Antagonists For Stress Ulcer Prophylaxis In Critically Ill Patients: A Systematic Review And Meta-Analysis

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a2562 ◽

2012 ◽

Author(s):

Waleed Al-Hazzani ◽

Farhan Alenzi ◽

Roman Jaeschke ◽

Paul Moayyedi ◽

Deborah J. Cook

Keyword(s):

Systematic Review ◽

Critically Ill ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Critically Ill Patients ◽

Stress Ulcer ◽

Meta Analysis ◽

Stress Ulcer Prophylaxis ◽

Receptor Antagonists ◽

Ulcer Prophylaxis

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Survey on the Prevalence of Intravenous Use of Proton Pump Inhibitors and H2-antagonists in Internal Medicine Ward

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2019/v28i230197 ◽

2019 ◽

pp. 1-6

Author(s):

Ebrahim Fallahzade ◽

Arian Aliabadi

Keyword(s):

Gastrointestinal Bleeding ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Stress Ulcer ◽

Stress Ulcer Prophylaxis ◽

Intervention Period ◽

Post Intervention ◽

H2 Antagonists ◽

Significant Change ◽

Ulcer Prophylaxis

Background: Anti-acids drugs are commonly used for stress ulcer prophylaxis (SUP). Some inpatients receiving acid suppression therapy without risk factors for nosocomial upper gastrointestinal bleeding and this inappropriate usage increase time, costs and avoidable side effects such as hospital-acquired pneumonia. Purpose: This study was designed to evaluate the prevalence of stress ulcer prophylactic drugs use, the number of properly indicated administrations and prescription prevalence of intravenous use of proton pump inhibitors (PIPs) and H2-antagonists in preventing nosocomial gastrointestinal bleeding and pneumonia. Methods: This cross-sectional study was performed on 280 patients in two different time zone before and after implementing of guidelines for SUP usage on the medical service in January and March of 2014(pre-intervention period) and January and march of 2015 (post-intervention period). Indicated anti-acid therapy for stress ulcer prophylaxis was defined according to the 1999 American Society of Health-System Pharmacists (ASHP) guidelines for the use of SUP. The Patient’s data such as kind of stress ulcer prophylaxis drug, ICU admission and the indication of prophylaxis pre and post-intervention were collected. Data were analyzed by SPSS software using the Pearson Chi-square test and unpaired t-test. Results: There was no significant change in the administration of stress ulcer prophylaxis drugs in general, but anti-acid medications misused decreased from 63.6% to 55.2% after intervention. Conclusion: The use of anti-acids without proper indication had 11.4% fall. The IV administration had a dramatic decrease as opposed to PO anti-acids use, which had a significant effect on hospital financial costs. In the end, there was no significant change detected in the total use of SUP (stress ulcer prophylaxis).

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Reducing Overuse of Proton Pump Inhibitors for Stress Ulcer Prophylaxis and Nonvariceal Gastrointestinal Bleeding in the Hospital: A Narrative Review and Implementation Guide

Journal of Hospital Medicine ◽

10.12788/jhm.3637 ◽

2021 ◽

Author(s):

Karen Clarke ◽

Nicole Adler ◽

Dimpal Bhakta ◽

Suchita Shah Sata ◽

Sarguni Singh ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Stress Ulcer ◽

Hospital Setting ◽

Narrative Review ◽

Stress Ulcer Prophylaxis ◽

Inpatient Setting ◽

Multifaceted Interventions ◽

Ulcer Prophylaxis

Proton pump inhibitors (PPIs) are among the most commonly used medications in the world; however, these drugs carry the risk of patient harm, including acute and chronic kidney disease, Clostridium difficile infection, hypomagnesemia, and fractures. In the hospital setting, PPIs are overused for stress ulcer prophylaxis and gastrointestinal bleeding, and PPI use often continues after discharge. Numerous multifaceted interventions have demonstrated safe and effective reduction of PPI use in the inpatient setting. This narrative review and the resulting implementation guide summarize published interventions to reduce inappropriate PPI use and provide a strategy for quality improvement teams.

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