Saudi Journal of Gastroenterology
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Year : 2010  |  Volume : 16  |  Issue : 4  |  Page : 275-279

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

1 Department Chair, Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
2 Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
3 Clinical Pharmacy Specialist King Fahad Medical City, Riyadh, Saudi Arabia
4 Clinical Pharmacy Specialist, BCPS, King Khalid University Hospital, Riyadh, Saudi Arabia

Correspondence Address:
Ahmed Y Mayet
Pharm.D., BCPS, Medication Safety Research Chair, Clinical Pharmacy Department,King Saud University, P.O.Box 2547 Riyadh 11451
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-3767.70614

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Background/Aim: 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. Materials and Methods: 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. Results: 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. Conclusion: 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.

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