Publication:

A study on assessment of inappropriate prescribing of proton pump inhibitors at a teaching hospital

Background Proton pump inhibitors (PPI’s) are amongst the most extensively utilized therapies for conditions characterized by excessive gastric-acid production, making them highly susceptible to inappropriate long-term use predisposing individuals to a higher risk of side effects. This study seeks to evaluate the prevalence and patterns of inappropriate PPI prescribing in both in-patients and out-patients, with a focus on adherence to clinical guidelines regarding indications, dosage, frequency, and duration of therapy by using National Institute for Health and Care Excellence (NICE) guidelines.

Methods Appropriateness of PPI prescriptions was prospectively assessed in 120 in-patients during their hospitalization and at discharge, and 50 out-patients with regard to the indication, dosage, frequency and duration of therapy for their compliance with NICE guidelines. The required data for the study was noted in a suitably designed data collection form.

Results Among 120 in-patients, 56 (46.67%) were males and 64 (53.33%) were females. Pantoprazole 40 mg was the commonly prescribed PPI, accounting 115 (95.83%) IV and 5 (4.17%) oral prescriptions among In-patients whereas 94 (93.07%) prescriptions account for pantoprazole 40 mg and 7 (6.93%) with rabeprazole 20 mg during discharge, all through an oral route. On assessing the appropriateness of prescription, it was revealed that 80 (66.67%) were appropriate, while 40 (33.33%) were inappropriate in IPD. In 35 inappropriate indications, 14 (40%) are due to prophylaxis in low-risk patients with concomitant use of NSAIDs and 1 (2.86%) with corticosteroids. Twenty (57.15%) prescriptions had no indications. Four (10%) prescriptions had inappropriate frequency and 1 (2.50%) had inappropriate duration. Among the out-patients, 32 (64%) were males and 18 (36%) females. Pantoprazole 40 mg was prescribed in 5 (10%) through an IV route and 32 (64%) were oral prescriptions whereas 13 (26%) were given rabeprazole 20 mg orally. Inappropriateness was seen in 14 (77.78%) due to prophylaxis in low-risk patients co-prescribed with NSAIDs and 4 (22.22%) prescriptions had no clear indications. Three (14.29%) accounted for inappropriate frequency.

Conclusions The study concludes that, the rate of inappropriate prescribing of PPIs is relatively low in both in-patients during hospitalization, at discharge, and in outpatients. Pharmacists can work closely with prescribers to ensure the proper indication, dose, frequency and duration of therapy.