TBA (16S172)

APPROPRIATENESS OF INTRAVENOUS (IV) PROTON PUMP INHIBITOR (PPI) USE IN AN ACUTE HOSPITAL

Author(s)

Tam, A[1]., Power, D[2]., Stack, W[2]., Jackson., S[2]. Murphy, A[2]. 

Department(s)/Institutions

[1] University College Cork, College Road, Cork.
[2] Bon Secours Hospital, College Road, Cork. 

Introduction

Intravenous proton pump inhibitors are frequently used in the hospital setting. The main indication for IV PPIs is in acute upper GI bleeding where a bleeding ulcer is suspected or established to be the cause. [1] The widespread use of PPIs has been controversial, having been linked to the development of nosocomial pneumonia in the intensive care setting [2] and to spontaneous bacterial peritonitis in cirrhotic patients [3]. There is some evidence that intravenous PPIs can be overused in hospitals where a much cheaper oral or sublingual formulation can be used.

Aims/Background

To record the use of intravenous PPI’s at the Bon Secours Hospital-Cork and to determine if they were appropriately prescribed. 

Method

In patients where an IV PPI was prescribed (n=30), data was recorded retrospectively including patient demographics, indications for PPI use, and whether an endoscopy was performed during the admission. Based on current internationally accepted guidelines two consultant gastroenterologists determined whether IV PPI use was appropriate or not. 

Results

Of 30 patients included in this study 18 (40%) were surgical and 12 were medical. Nine (30%) of patients were already on an oral PPI when an IV PPI was commenced and 21(70%) were discharged on an oral PPI. 180 IV PPI doses were administered with a mean of 6 doses per patient. Six (20%) of patients had an upper GI bleed as the primary indication for an IV PPI. Endoscopy was performed on 8 (27%) of patients and of these 1 (12.5%) had a visible vessel in an ulcer as the suspected cause of the bleed. 17 (60%) of patients were nil by mouth when commenced on an IV PPI. The choice of an intravenous PPI was determined to be appropriate in 10 (33%) cases. It was also determined that an oral PPI could have been used in 22 (73%) cases if necessary.

Conclusions

This indicates that significant overuse of intravenous PPIs in an inpatient setting where an oral or sublingual formulation should be considered. More stringent adherence to guidelines in relation to IV PPIs could result in possible reduced inpatient complications and also reduce hospital drug costs.