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proton pump inhibitors overused in the hospitalized patients
overuse proton pump inhibitors in the hospitalized patients
PPIs overuse , PPIs inappropriate ,
PPIs misuse
Overuse Of Proton Pump InhibitorsIn Hospitalized Patients Introduction:
Proton pump inhibitors (PPIs) are the most potent suppressors of gastric acid. They act by inhibiting the secretion of hydrogen ions into gastric lumen ,through binding with proton pump (an H+/K+ATP pump) of the parietal cells, which represents the final step in the physiologic pathway of gastric acid secretion.They are among the commonest medications prescribed worldwide, for the treatment of upper gastrointestinal diseases like gastroesophageal reflux disease, peptic ulcer disease, and as agents in Helicobacter pylori eradication regimens.PPIs are administered orally as inactive prodrug.They are then converted to active form in the intestinal lumen. The active drug forms a covalent disulfide bond with α-subunit of H+/K+ATPase, and irreversibly inactivates the enzyme.Metabolism of PPIs drugs is mediated by the hepatic cytochrome P450 enzyme.PPIs suppress acid secretion for prolonged periods of time(48-72 hour), so continuous treatment can lead to markedly decreased hydrochloric acid(HCL) out put, resulting in a clinically significant symptomatic relief.Owing to the powerful acid suppressive effect of PPIs, their use in hospitalized patients is widely practiced especially in the management of upper gastrointestinal bleeding and the prevention of stress-induced erosive gastritis. They are also commonly prescribed for upper gastrointestinal symptoms attributed to analgesics use.
Aim and objective:We aim to explore the current practice of prescribing PPIs for hospitalized patients, in terms of frequency, indications, and appropriateness, and to estimate their overuse and its health and economic impacts.
Methods:Data will be collected from patients' files in the general wards, intensive care unit (ICU), and coronary care unit (CCU). These will include age, sex, reason for hospitalization, chronic disease(s), any clear indication for PPIs (and the route of administration/subtype of PPI/doses/duration), other medications administered, clinical course, and outcome.The clinical data will be analyzed to find out the magnitude of inappropriate use of PPIs in hospitalized patients, and to extrapolate the possible future risks. In addition, the economic consequences will be also highlighted.