Overuse of acid-suppressive therapy in hospitalized patients

• Published in: The American journal of gastroenterology Vol. 95; no. 11; pp. 3118 - 3122
• Main Authors: Nardino, Robert J, Vender, Ronald J, Herbert, Peter N
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Inc 01-11-2000; Blackwell Publishing
• Subjects: Antacids - therapeutic use; Anti-Ulcer Agents - therapeutic use; Biological and medical sciences; Digestive system; Drug Utilization; Female; Histamine H2 Antagonists - therapeutic use; Hospitalization; Humans; Male; Medical sciences; Patient Discharge; Peptic Ulcer - etiology; Peptic Ulcer - prevention & control; Pharmacology. Drug treatments; Proton Pump Inhibitors; Stress, Physiological - complications; Human; Chemotherapy; Indication; Medical prescription; Antisecretory agent; Hospital; Epidemiology; Public health; Incidence
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1016/S0002-9270(00)02052-9

OBJECTIVES:
The aims of this study were 1) to determine the frequency of use and indications for prescription of acid-suppressive medications in hospitalized patients, and 2) to determine whether patients who are prescribed these medications for stress ulcer prophylaxis are prescribed them on hospital discharge.
METHODS:
The use of acid-suppressive medications (histamine-2 receptor antagonists, proton pump inhibitors, and barriers—specifically, famotidine, omeprazole, and sucralfate) was assessed in 226 patients admitted consecutively to a general medical nursing unit of an urban, community, teaching hospital. Chart review was undertaken to determine the type of medication used, timing of prescription, and indication for use.
RESULTS:
Of hospitalized patients, 54% were receiving acid-suppressive therapy. Histamine-2 receptor antagonists were used most frequently (62%). In all, 65% of prescriptions were not indicated as determined by consensus review. Among patients put on acid-suppressive therapy for ulcer prophylaxis, 55% were discharged on the therapy.
CONCLUSIONS:
There is significant overuse of acid-suppressive therapy in hospitalized patients. The problem of placing low-risk patients on ulcer prophylaxis unnecessarily is compounded by discharging these patients with the medication.