Who gets prescriptions for proton pump inhibitors and why? A drug-utilization study with claims data in Bavaria, Germany, 2010–2018

Purpose The German annual drug prescription-report has indicated overuse of proton pump inhibitors (PPIs) for many years; however, little was known about the characteristics of people using PPIs. This study aimed to provide comprehensive utilization data and describe frequencies of potential on- and off-label PPI-indications in Bavaria, Germany. Methods Claims data of statutorily insured people from 2010 to 2018 were used. Defined daily doses (DDDs) of PPIs by type of drug, prevalence of PPI-use and DDDs prescribed per 1000 insured people/day were analyzed. For 2018, proportions of users and DDDs per 1000 insured people were calculated by age and sex. To elucidate changes in prescribing practices due to a suspected drug-drug interaction, we examined co-prescribing of clopidogrel and PPIs between 2010 and 2018. For PPI new users, sums of DDDs and frequencies of potential indications were examined. Results PPI prescribing increased linearly from 2010 to 2016 and gradually decreased from 2016 to 2018. In 2018, 14.7% of women and 12.2% of men received at least one prescription, and 64.8 DDDs (WHO-def.) per 1000 insured people/day were prescribed. Overall, omeprazole use decreased over the observation period and was steadily replaced by pantoprazole, especially when co-prescibed with clopidogrel. An on-label PPI-indication was not reported at first intake in 52.0% of new users. Conclusions The utilization of prescribed PPIs has decreased since 2016. However, a large proportion of new PPI-users had no documentation of a potential indication, and the sums of DDDs prescribed often seemed not to comply with guidelines.

Adherence to Direct Oral Anticoagulants in Patients With Non-Valvular Atrial Fibrillation: A Cross-National Comparison in Six European Countries (2008–2015)

Aims: To describe and compare the adherence to different direct oral anticoagulants (DOACs) in eight European databases representing six countries.Methods: Longitudinal drug utilization study of new users (≥18 years) of DOACs (dabigatran, rivaroxaban, apixaban) with a diagnosis of non-valvular atrial fibrillation (2008–2015). Adherence was examined by estimating persistence, switching, and discontinuation rates at 12 months. Primary non-adherence was estimated in BIFAP and SIDIAP databases.Results: The highest persistence rate was seen for apixaban in the CPRD database (81%) and the lowest for dabigatran in the Mondriaan database (22%). The switching rate for all DOACs ranged from 2.4 to 13.1% (Mondriaan and EGB databases, respectively). Dabigatran had the highest switching rate from 5.0 to 20.0% (Mondriaan and EGB databases, respectively). The discontinuation rate for all DOACs ranged from 16.0 to 63.9% (CPRD and Bavarian CD databases, respectively). Dabigatran had the highest rate of discontinuers, except in the Bavarian CD and AOK NORDWEST databases, ranging from 23.2 to 64.6% (CPRD and Mondriaan databases, respectively). Combined primary non-adherence for examined DOACs was 11.1% in BIFAP and 14.0% in SIDIAP. There were differences in population coverage and in the type of drug data source among the databases.Conclusion: Despite the differences in the characteristics of the databases and in demographic and baseline characteristics of the included population that could explain some of the observed discrepancies, we can observe a similar pattern throughout the databases. Apixaban was the DOAC with the highest persistence. Dabigatran had the highest proportion of discontinuers and switchers at 12 months in most databases (EMA/2015/27/PH).

Drug utilization study on pediatric pneumonia patients in a tertiary care teaching hospital

Background: Pneumonia remains the prime infectious disease that increases the mortality rate among children under five claimed the lives of nearly 1.5 million children in 2015. Mortality due to childhood pneumonia is linked to the prevalence and relapse increases and usage of antibiotics is more. In such circumstances, the main. Aim: The Aim of the study was to assess the utilization of drugs and to spot the factors that contribute to the pediatric pneumonia patients at tertiary care teaching hospitals. Material and methods: A prospective, observational study was conducted from May 2021 to October 2021Overall 310 prescriptions were collected, 204 patients were included in the study based on inclusion criteria and data was collected from a proforma and by using WHO prescribing indicators study is analyzed. Results: Age group with pneumonia of<5years was 171 patients, followed by 33 patients between 6-8years.The male children constituted the major portion i.e. 120(58.82%) followed by female children were 84(41.18%). Distribution of drugs per prescription, majority of prescriptions with<5 drugs i.e., 110(56%) followed by 82 prescriptions with 5-10 drugs constituted (43%), this indicates the polypharmacy and 1 prescription with >10 drugs i.e., (1%). The distribution of antibiotics where majorly preferred drug in penicillin’s were amoxiclav- 164(59.20%), least preferred was piperacillin/tazobactam-9(3.28%), followed by cefotaxime-38(13.71%), ceftriaxone -17(6.13%), amikacin- 31(11.19%), and azithromycin- 18(6.49%). Conclusion: In our study, we observed an irrational use of antibiotics and polypharmacy of drugs in the treatment of pediatric pneumonia.