Overutilization of proton pump inhibitors and H2 receptor antagonists in hospitalized medical patients
Abstract
Objective: The aim of the study was to determine the frequency of the use
of proton pump inhibitors (PPI) and histamine-2 receptor antagonists (H2RA),
which are widely used drugs, in the medical wards.
Method: We retrospectively retrieved medical records of the patients who
were hospitalized between January 1st and December 31th, 2010 in a tertiary
care university hospital internal medicine wards and medical intensive care
unit (MICU); one fourth of the cases who used a H2RA or a PPI drugs were
randomly selected for the study.
Results: In 2010, half of 4730 patients who admitted to internal medicine
wards was ordered a H2RA or a PPI. Of these, 556 patients (25.5%) were
evaluated. Majority of the patient (76%) were on PPI. While 90.3% of the
patients used a PPI in wards, 74.8% of the patients used a H2RA in the MICU
(p<0.001). Sixty-one percent (58/95) of patients who were transferred from
the MICU to wards were switched from a H2RA to a PPI without a specific
reason. Before admission, 8% of patients was on PPI and 5% on H2RA but at
discharge, utilization significantly increased, 79% for PPI and 21% for H2RA
(p<0.001).
Conclusions: There is a high rate of acid suppressive therapy usage among
hospitalized patients and similarly high rate of prescription at discharge.
Further studies are required to evaluate the appropriateness of the utilization
of these drugs.
Keywords
Proton pump inhibitor histamine-2 receptor antagonist gastrointestinal prophylaxis internal medicine
References
- 1. Ali T and Harty RF, Stress-induced ulcer bleeding in critically ill patients. Gastroenterol Clin North Am 2009; 38: 245-65.
- 2. ASHP Therapeutic Guidelines on Stress Ulcer Prophylaxis. ASHP Commission on Therapeutics and approved by the ASHP Board of Directors on November 14, 1998. Am J Health Syst Pharm 1999; 56: 347-79.
- 3. Di Mario F and Goni E, Gastric acid secretion: changes during a century. Best Pract Res Clin Gastroenterol 2014; 28: 953-65.
- 4. Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, Gangarosa LM, Thiny MT, Stizenberg K, Morgan DR, Ringel Y, Kim HP, Dibonaventura MD, Carroll CF, Allen JK, Cook SF, Sandler RS, Kappelman MD, and Shaheen NJ, Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 2012; 143: 1179-87 e1-3.
- 5. Suhonen J, Pirttila T, Erkinjuntti T, Koponen H, Makkonen M, Puurunen M, Raivio M, Rinne J, Rosenvall A, Strandberg T, Vanninen R, Vataja R, Suomalaisen Laakariseuran D, Societas Gerontologica F, Suomen Neurologisen Y, Suomen Psykogeriatrisen Y, and Suomen Yleislaaketieteen Yhdistyksen Asettama T, [Update on current care guidelines. The diagnosis and medical treatment of memory disorders]. Duodecim 2010; 126: 2167-8.
- 6. Nardino RJ, Vender RJ, and Herbert PN, Overuse of acid-suppressive therapy in hospitalized patients. Am J Gastroenterol 2000; 95: 3118-22.
- 7. Farrell CP, Mercogliano G, and Kuntz CL, Overuse of stress ulcer prophylaxis in the critical care setting and beyond. J Crit Care 2010; 25: 214-20.
- 8. Heidelbaugh JJ, Goldberg KL, and Inadomi JM, Overutilization of proton pump inhibitors: a review of cost-effectiveness and risk [corrected]. Am J Gastroenterol 2009; 104 Suppl 2: S27-32.
- 9. Kaplan GG, Bates D, McDonald D, Panaccione R, and Romagnuolo J, Inappropriate use of intravenous pantoprazole: extent of the problem and successful solutions. Clin Gastroenterol Hepatol 2005; 3: 1207-14.
- 10. Muscat M, Shefer A, Ben Mamou M, Spataru R, Jankovic D, Deshevoy S, Butler R, and Pfeifer D, The state of measles and rubella in the WHO European Region, 2013. Clin Microbiol Infect 2014; 20 Suppl 5: 12-8.
- 11. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL, International Surviving Sepsis Campaign Guidelines C, American Association of Critical-Care N, American College of Chest P, American College of Emergency P, Canadian Critical Care S, European Society of Clinical M, Infectious D, European Society of Intensive Care M, European Respiratory S, International Sepsis F, Japanese Association for Acute M, Japanese Society of Intensive Care M, Society of Critical Care M, Society of Hospital M, Surgical Infection S, World Federation of Societies of I, and Critical Care M, Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008; 36: 296-327.
- 12. Lau JY, Leung WK, Wu JC, Chan FK, Wong VW, Chiu PW, Lee VW, Lee KK, Cheung FK, Siu P, Ng EK, and Sung JJ, Omeprazole before endoscopy in patients with gastrointestinal bleeding. N Engl J Med 2007; 356: 1631-40.
- 13. Niklasson A, Bajor A, Bergendal L, Simren M, Strid H, and Bjornsson E, Overuse of acid suppressive therapy in hospitalised patients with pulmonary diseases. Respir Med 2003; 97: 1143-50.
- 14. Grube RR and May DB, Stress ulcer prophylaxis in hospitalized patients not in intensive care units. Am J Health Syst Pharm 2007; 64: 1396-400.
- 15. Thomas L, Culley EJ, Gladowski P, Goff V, Fong J, and Marche SM, Longitudinal analysis of the costs associated with inpatient initiation and subsequent outpatient continuation of proton pump inhibitor therapy for stress ulcer prophylaxis in a large managed care organization. J Manag Care Pharm 2010; 16: 122-9.
- 16. Lam JR, Schneider JL, Zhao W, and Corley DA, Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013; 310: 2435-42.
- 17. Lau AN, Tomizza M, Wong-Pack M, Papaioannou A, and Adachi JD, The relationship between long-term proton pump inhibitor therapy and skeletal frailty. Endocrine 2015.
- 18. Barletta JF and Sclar DA, Proton pump inhibitors increase the risk for hospital-acquired Clostridium difficile infection in critically ill patients. Crit Care 2014; 18: 714.
- 19. Alqutub AN and Masoodi I, A case of gastric polyposis in antral area of stomach following prolonged proton-pump therapy. Ger Med Sci 2010; 8.
- 20. Lambert AA, Lam JO, Paik JJ, Ugarte-Gil C, Drummond MB, and Crowell TA, Risk of community-acquired pneumonia with outpatient proton-pump inhibitor therapy: a systematic review and meta-analysis. PLoS One 2015; 10: e0128004.
- 21. MacLaren R, Kassel LE, Kiser TH, and Fish DN, Proton pump inhibitors and histamine-2 receptor antagonists in the intensive care setting: focus on therapeutic and adverse events. Expert Opin Drug Saf 2015; 14: 269-80.
- 22. Scott SA, Owusu Obeng A, and Hulot JS, Antiplatelet drug interactions with proton pump inhibitors. Expert Opin Drug Metab Toxicol 2014; 10: 175-89.
- 23. Cuevas-Castillejos H, Cuevas-Castillejos JE, Garcia-Murray O, and Larenas-Linnemann D, [Allergy to ranitidine: one case report and literature review]. Rev Alerg Mex 2013; 60: 41-8.
- 24. Elzinga-Huttenga J, Hekster Y, Bijl A, and Rotteveel J, Movement disorders induced by gastrointestinal drugs: two paediatric cases. Neuropediatrics 2006; 37: 102-6.
- 25. Valuck RJ and Ruscin JM, A case-control study on adverse effects: H2 blocker or proton pump inhibitor use and risk of vitamin B12 deficiency in older adults. J Clin Epidemiol 2004; 57: 422-8.
- 26. Lee YC and Wang CC, Famotidine-induced retinopathy. Eye (Lond) 2006; 20: 260-3.
- 27. Schoenwald PK, Sprung J, Abdelmalak B, Mraovic B, Tetzlaff JE, and Gurm HS, Complete atrioventricular block and cardiac arrest following intravenous famotidine administration. Anesthesiology 1999; 90: 623-6.
- 28. Hirayama K, Hanatsuka K, Ikeuchi T, Shida D, Ohtsuka K, Yoshimi F, Hori M, Itabashi M, and Koyama A, Famotidine-induced acute interstitial nephritis. Nephrol Dial Transplant 1998; 13: 2636-8.
Proton pompa inhibitörleri ve H2 reseptör antagonistlerinin iç hastalıkları servislerinde yatmakta olan hastalarda aşırı kullanımı
Abstract
Amaç: Hastanede yatmakta olan
hastalarda proton pompa inhibitörleri (PPİ) ve histamine-2 reseptör
antagonistlerinin (H2RA) kullanılma sıklığı ve tercihine ilişkin veriler
yoktur.
İç Hastalıkları servislerinde sık olarak kullanılan PPİ ve H2RA
kullanım sıklıklarını belirlemektir.
Yöntem: Retrospektif
olarak, 1 Ocak ve 31 Aralık 2010 tarihleri arasında bir üçüncü basamak
üniversite hastanesinin İç Hastalıkları servislerinde ve yoğun bakım
ünitelerinde (YBÜ) yatırılan hastaların tıbbi kayıtları incelendi; herhangi bir
PPİ veya H2RA kullanımı olan olguların dörtte biri rastgele olacak şekilde
seçildi.
Bulgular: 2010
yılında, İç Hastalıkları servislerinde yatırılan toplam 4730 hastanın yarısı
bir H2RA veya PPİ kullanmıştı. Bunların içinden 556 (%25.5) olgu incelendi.
Olguların büyük çoğunluğu (%76) PPİ kullanmaktaydı. Servislerde, PPİ olguların
%90.3’ünde kullanılırken, YBÜ’de olguların %74.8’i H2RA kullanmaktaydı
(p<0.001). YBÜ’den servislere transfer edilen olguların %61’inde (58/95),
herhangi özel bir neden olmadan, H2RA kesilerek PPİ kullanımına geçildiği
görüldü. Hastaneye yatmadan önce olguların %8’i PPİ ve %5’i bir H2RA
kullanırken, taburculuk sırasında %79 PPİ ve %21 H2RA olacak şekilde kullanım
anlamlı şekilde artmıştı (p<0.001).
Sonuç: Hastanede yatmakta
olan hastalarda ve taburcu edilirken verilen reçetelerde yüksek oranda asit
baskılayıcı tedavi kullanılmaktadır. Bu ilaçların akılcı şekilde kullanılma
durumlarını değerlendirmek için ileri araştırmalara ihtiyaç vardır.
Keywords
Proton pompa inhibitörü histamine-2 reseptör antagonisti gastrointestinal profilaksi İç Hastalıkları asit baskılayıcı tedavi
References
- 1. Ali T and Harty RF, Stress-induced ulcer bleeding in critically ill patients. Gastroenterol Clin North Am 2009; 38: 245-65.
- 2. ASHP Therapeutic Guidelines on Stress Ulcer Prophylaxis. ASHP Commission on Therapeutics and approved by the ASHP Board of Directors on November 14, 1998. Am J Health Syst Pharm 1999; 56: 347-79.
- 3. Di Mario F and Goni E, Gastric acid secretion: changes during a century. Best Pract Res Clin Gastroenterol 2014; 28: 953-65.
- 4. Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, Gangarosa LM, Thiny MT, Stizenberg K, Morgan DR, Ringel Y, Kim HP, Dibonaventura MD, Carroll CF, Allen JK, Cook SF, Sandler RS, Kappelman MD, and Shaheen NJ, Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 2012; 143: 1179-87 e1-3.
- 5. Suhonen J, Pirttila T, Erkinjuntti T, Koponen H, Makkonen M, Puurunen M, Raivio M, Rinne J, Rosenvall A, Strandberg T, Vanninen R, Vataja R, Suomalaisen Laakariseuran D, Societas Gerontologica F, Suomen Neurologisen Y, Suomen Psykogeriatrisen Y, and Suomen Yleislaaketieteen Yhdistyksen Asettama T, [Update on current care guidelines. The diagnosis and medical treatment of memory disorders]. Duodecim 2010; 126: 2167-8.
- 6. Nardino RJ, Vender RJ, and Herbert PN, Overuse of acid-suppressive therapy in hospitalized patients. Am J Gastroenterol 2000; 95: 3118-22.
- 7. Farrell CP, Mercogliano G, and Kuntz CL, Overuse of stress ulcer prophylaxis in the critical care setting and beyond. J Crit Care 2010; 25: 214-20.
- 8. Heidelbaugh JJ, Goldberg KL, and Inadomi JM, Overutilization of proton pump inhibitors: a review of cost-effectiveness and risk [corrected]. Am J Gastroenterol 2009; 104 Suppl 2: S27-32.
- 9. Kaplan GG, Bates D, McDonald D, Panaccione R, and Romagnuolo J, Inappropriate use of intravenous pantoprazole: extent of the problem and successful solutions. Clin Gastroenterol Hepatol 2005; 3: 1207-14.
- 10. Muscat M, Shefer A, Ben Mamou M, Spataru R, Jankovic D, Deshevoy S, Butler R, and Pfeifer D, The state of measles and rubella in the WHO European Region, 2013. Clin Microbiol Infect 2014; 20 Suppl 5: 12-8.
- 11. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL, International Surviving Sepsis Campaign Guidelines C, American Association of Critical-Care N, American College of Chest P, American College of Emergency P, Canadian Critical Care S, European Society of Clinical M, Infectious D, European Society of Intensive Care M, European Respiratory S, International Sepsis F, Japanese Association for Acute M, Japanese Society of Intensive Care M, Society of Critical Care M, Society of Hospital M, Surgical Infection S, World Federation of Societies of I, and Critical Care M, Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008; 36: 296-327.
- 12. Lau JY, Leung WK, Wu JC, Chan FK, Wong VW, Chiu PW, Lee VW, Lee KK, Cheung FK, Siu P, Ng EK, and Sung JJ, Omeprazole before endoscopy in patients with gastrointestinal bleeding. N Engl J Med 2007; 356: 1631-40.
- 13. Niklasson A, Bajor A, Bergendal L, Simren M, Strid H, and Bjornsson E, Overuse of acid suppressive therapy in hospitalised patients with pulmonary diseases. Respir Med 2003; 97: 1143-50.
- 14. Grube RR and May DB, Stress ulcer prophylaxis in hospitalized patients not in intensive care units. Am J Health Syst Pharm 2007; 64: 1396-400.
- 15. Thomas L, Culley EJ, Gladowski P, Goff V, Fong J, and Marche SM, Longitudinal analysis of the costs associated with inpatient initiation and subsequent outpatient continuation of proton pump inhibitor therapy for stress ulcer prophylaxis in a large managed care organization. J Manag Care Pharm 2010; 16: 122-9.
- 16. Lam JR, Schneider JL, Zhao W, and Corley DA, Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013; 310: 2435-42.
- 17. Lau AN, Tomizza M, Wong-Pack M, Papaioannou A, and Adachi JD, The relationship between long-term proton pump inhibitor therapy and skeletal frailty. Endocrine 2015.
- 18. Barletta JF and Sclar DA, Proton pump inhibitors increase the risk for hospital-acquired Clostridium difficile infection in critically ill patients. Crit Care 2014; 18: 714.
- 19. Alqutub AN and Masoodi I, A case of gastric polyposis in antral area of stomach following prolonged proton-pump therapy. Ger Med Sci 2010; 8.
- 20. Lambert AA, Lam JO, Paik JJ, Ugarte-Gil C, Drummond MB, and Crowell TA, Risk of community-acquired pneumonia with outpatient proton-pump inhibitor therapy: a systematic review and meta-analysis. PLoS One 2015; 10: e0128004.
- 21. MacLaren R, Kassel LE, Kiser TH, and Fish DN, Proton pump inhibitors and histamine-2 receptor antagonists in the intensive care setting: focus on therapeutic and adverse events. Expert Opin Drug Saf 2015; 14: 269-80.
- 22. Scott SA, Owusu Obeng A, and Hulot JS, Antiplatelet drug interactions with proton pump inhibitors. Expert Opin Drug Metab Toxicol 2014; 10: 175-89.
- 23. Cuevas-Castillejos H, Cuevas-Castillejos JE, Garcia-Murray O, and Larenas-Linnemann D, [Allergy to ranitidine: one case report and literature review]. Rev Alerg Mex 2013; 60: 41-8.
- 24. Elzinga-Huttenga J, Hekster Y, Bijl A, and Rotteveel J, Movement disorders induced by gastrointestinal drugs: two paediatric cases. Neuropediatrics 2006; 37: 102-6.
- 25. Valuck RJ and Ruscin JM, A case-control study on adverse effects: H2 blocker or proton pump inhibitor use and risk of vitamin B12 deficiency in older adults. J Clin Epidemiol 2004; 57: 422-8.
- 26. Lee YC and Wang CC, Famotidine-induced retinopathy. Eye (Lond) 2006; 20: 260-3.
- 27. Schoenwald PK, Sprung J, Abdelmalak B, Mraovic B, Tetzlaff JE, and Gurm HS, Complete atrioventricular block and cardiac arrest following intravenous famotidine administration. Anesthesiology 1999; 90: 623-6.
- 28. Hirayama K, Hanatsuka K, Ikeuchi T, Shida D, Ohtsuka K, Yoshimi F, Hori M, Itabashi M, and Koyama A, Famotidine-induced acute interstitial nephritis. Nephrol Dial Transplant 1998; 13: 2636-8.
Details
| Subjects | Health Care Administration |
|---|---|
| Journal Section | Medical Science Research Articles |
| Authors | |
| Publication Date | May 16, 2017 |
| Acceptance Date | April 25, 2017 |
| Published in Issue | Year 2017Volume: 39 Issue: 2 |