Abstract

To the Editor:

We read with interest the publication by Gupta et al¹ on inappropriate use of acid suppression therapy (AST) in the hospital setting. Apart from being overused, they also showed that there were no predictive factors of inappropriate prescription of AST, including concomitant use of ulcerogenic drugs. Our experience has been similar both in the inpatient and outpatient settings. We recently conducted a prospective, hospital-based survey on proton pump inhibitor (PPI) use in the outpatient clinic setting. An average of 1,086 prescriptions (range 1,035 to 1,157) was processed per day, 8% (range 6 to 11%) of which included PPIs. Only 32% of the PPI prescriptions had a concomitant prescription of ulcerogenic drugs (antiplatelet agents, NSAIDs or steroids). Forty-six percent of the PPI prescriptions were in patients older than 60 years, and only 50% had coprescriptions of ulcer-causing medications. Interestingly, the NSAIDs used consisted mainly of those categorized as low ulcerogenic risks (ibuprofen and diclofenac). Our survey showed frequent PPI use in which the majority could be considered inappropriate, or with weak indication. In the last year, PPIs ranked fifth in terms of overall cost of medications to our national health service. As our study was pharmacy based and we could only use patients' prescription cards, we were not able to obtain additional information such as a history of peptic ulcer disease or previous gastrointestinal bleeding. However, our results are consistent with what have been reported for hospitalized patients.