Original Article

Overuse of Acid Suppression Therapy in Hospitalized Patients

Authors: Ruchi Gupta, MD, Praveen Garg, MD, Ravi Kottoor, MD, Juan Carlos Munoz, MD, M. Mazen Jamal, MD, Louis R. Lambiase MD, Kenneth J. Vega, MD

Abstract


Background: Acid suppression therapy (AST) is one of the most commonly prescribed classes of medications in hospitalized patients. Multiple studies have shown that AST is overused during inpatient admissions. However, minimal data is available regarding the frequency and patient characteristics of those discharged on unnecessary AST. The aims of the study were to examine administration of AST on admission, to characterize the patient population discharged on unnecessary AST and to determine predictive factors for inappropriate administration of AST in hospitalized patients.


Methods: A retrospective chart review of randomly selected patients admitted to the general medicine service at University of Florida Health Science Center/Jacksonville from August to October 2006 for appropriateness of AST was done. The admitting diagnosis, indications for starting AST, type of AST used, and discharge on these medications was recorded on a case by case basis.


Results: Seventy percent of patients were started on AST on admission. Of these, 73% were unnecessary. Stress ulcers prophylaxis in low risk patients or the concomitant use of ulcerogenic drugs motivated initiation of therapy most frequently. Sixty nine percent of patients started on inappropriate AST were discharged on the same regimen. Admitting diagnosis, age of patient, length of stay, or concomitant use of ulcerogenic drugs did not predict continuation of unnecessary AST at discharge.


Conclusion: AST is overused in hospitalized patients. This primarily occurred in low risk patients and was compounded by continuation at discharge. This significantly increases cost to the health care system and the risk of drug interactions.



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References

1.Aciphex® Prescribing Information. Ridgefield Park, New Jersey, Eisai Inc, January 2009.
 
2.Nexium® Prescribing Information. Wilmington, DE, AstraZeneca, June 2009.
 
3.Prevacid® Prescribing Information. Deerfield, IL, Takeda Pharmaceuticals, Inc., May 2009.
 
4.Prilosec® Prescribing Information. Wilmington, DE, AstraZeneca, March 2008.
 
5.Protonix® Prescribing Information. Philadelphia, PA, Wyeth Pharmaceuticals, Inc., May 2008.
 
6.Zegerid™ Prescribing Information. San Diego, CA, Santarus, Inc., January 2008.
 
7.Cook DJ, Reeve BK, Guyatt GH, et al. Stress ulcer prophylaxis in critically ill patients. Resolving discordant meta-analyses. JAMA 1996;275:308–314.
 
8.Ben-Menachem T, Fogel R, Patel RV, et al. Prophylaxis for stress-related gastric hemorrhage in the medical intensive care unit. A randomized, controlled, single- blind study. Ann Intern Med 1994;121:568–575.
 
9.American Society of Health System Pharmacists. ASHP therapeutic guidelines on stress ulcer prophylaxis. Am J Health Syst Pharm 1999;56:347–379.
 
10.Cash BD. Evidence based medicine as it applies to acid suppression in the hospitalized patient. Crit Care Med 2002;30:s373–s378.
 
11.Conn HO, Poynard T. Corticosteroids and peptic ulcer: metanalysis of adverse events during steroid therapy. J Intern Med 1999;236:619–632.
 
12.Piper JM, Ray WA, Daugherty JR, et al. Corticosteroid use and peptic ulcer disease: role of non steroidal anti inflammatory drugs. Ann Intern Med 1991;114:735–740.
 
13.Zink DA, Pohlman M, Barnes M, et al. Long-term use of acid suppression started inappropriately during hospitalization. Aliment Pharmacol Ther 2005;21:1203–1209.
 
14.Parente F, Cucino C, Gallus S, et al. Hospital use of acid suppressive medications and its fall-out on prescribing in general practice: a 1-month survey. Aliment Pharmacol Ther 2003;17:1503–1506.
 
15.Heidelbaugh JJ, Inadomi JM. Magnitude and economic impact of inappropriate use of stress ulcer prophylaxis in non-ICU hospitalized patients. Am J Gastroenterol 2006;101:2200–2205.
 
16.Gerson LB, Triadafilopoulos G. Proton pump inhibitors and their drug interaction: an evidence based approach. Eur J Gastroenterol Hepatol 2001;13:611–616.
 
17.Dial S, Alrasadi K, Manoukian C, et al. Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: Cohort and case control studies. Can Med Assoc 2004;171:33–38.
 
18.Laheij R, Sturkenboom M, Hsaaings RJ, et al. Risk of community acquired pneumonia and use of gastric acid suppressive drugs. JAMA 2004;292:1955–1960.
 
19.Donskey CJ. The role of intestinal tract as a reservoir and source for transmission of nosocomial pathogens. Clin Infect Dis 2004;39:219–226.
 
20.Leonard J, Marshall JK, Moayyedi P. Systematic review of the risk of enteric infection in patient taking acid suppression. Am J Gastroenterol 2007;102:2047–2056.
 
21.Nardino RJ, Vender RJ, Herbert PN. Overuse of acid-suppressive therapy in hospitalized patients. Am J Gastroenterol 2000;95:3118–3122.
 
22.Yap KB, Chan KM. The prescribing pattern of hospital doctors. Singapore Med J 1998;39:496–500.