Predictores de Prescrição Inadequada de Inibidores da Bomba de Protões num Serviço de Medicina Interna
Palavras-chave:Departamentos Hospitalares, Inibidores da Bomba de Protões/uso terapêutico, Medicina Interna, Prescrição Inapropriada
Introduction: Proton pump inhibitors (PPIs) are used in the
treatment of gastrointestinal pathology and prevention of upper
gastrointestinal bleeding. They are frequently misused in
Methods: We conducted an observational cross-sectional
study between 15th March and 15th May 2015 to evaluate the
prescription pattern of PPIs in an Internal Medicine ward regarding
indications and costs.
Results: Five hundred and eighty five admissions were included
with an average age of 75 years. One hundred and sixty
three cases were medicated with a PPI prior to admission, half
of them without indication. Three hundred seventy-two cases
were prescribed a PPI on admission/during hospital stay
but only 63 cases had a proper indication meaning that 83%
were inadequately medicated. Predictors of inadequate PPI
prescription were female sex, age ≥ 75 years and being medicated
with a PPI prior to admission.
Conclusion: Total costs, directly related to PPIs were set at
€1079.96, on average €2.72 per episode. Therapy with PPIs
should be reviewed to decrease inadequate prescriptions and
Heidelbaugh JJ, Kim AH,Chang R, andWalker PC. Overutilization of proton-pump inhibitors: what the clinician needs to know. Therap Adv Gastroenterol. 2012; 5: 219–32.
Kahrilas PJ, Shaheen NJ, Vaezi MF. American Gastroenterological Association Institute technical review on the management of gastro-oesophageal reflux disease. Gastroenterology. 2008;135:1392–413.
Freston JW. Review article: role of proton pump inhibitors in non-H. Pylori-related ulcers. Aliment Pharmacol Ther. 2001;15(Suppl 2):2–5.
Malfertheiner P, Megraud F, OÂ´Morain C, Bazzoli F, El-Omar E, Graham D, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut. 2007;56:772–81.
Wilcox CM, Hirschowitz BI. Treatment strategies for Zollinger-Ellison syndrome. Expert Opin Pharmacother. 2009;10:1145–57.
Wang WH, Huang JQ, Zheng GF, Xia HH, Wong WM, Liu XG, et al. Effects of proton-pump inhibitors on functional dyspepsia: a meta-analysis of randomized placebo-controlled trials. Clin Gastroenterol Hepatol. 2007;5:178-85.
Abraham NS, Hlatky M, Antman EM, Bhatt DL, Bjorkman DJ, Clark CB, et al. EXPERT CONSENSUS DOCUMENT ACCF / ACG / AHA 2010 Expert Consensus Document on the Concomitant Use of Proton Pump Inhibitors and Thienopyridines: A Focused Update of the ACCF / ACG / AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks. J Am Coll Cardiol. 2010;56:2051–66.
Moukarbel GV,Bhatt DL. Antiplatelet therapy and proton pump inhibition: clinician update. Circulation. 2012;125:375-80
Lanza FL, Chan FK, Quigley EM. Guidelines for Prevention of NSAID-related ulcer complications. Am Gastroenterol. 2009;104:728–38.
Retornaz F, Boullu-Ciocca S, Farcet A, Oliver C. Arret de la corticotherapie chez la personne agee. Geriatr Psychol Neuropsychiatr Vieil. 2013;11:361-6.
Haroon M, Yasin F, Gardezi SK, Adeeb F, Walker F. Inappropriate use of proton pump inhibitors among medical inpatients: a questionnaire-based observational study. JRSM Short Rep. 2013;4:36.
Hughes JD, Tanpurekul W, Keen NC, Ee HC. Reducing the cost of proton pump inhibitors by adopting best practice. Qual Prim Care. 2009;17:15–21.
Ahrens D, Chenot JF, Behrens G, Grimmsmann T, Kochen MM. Appropriateness of treatment recommendations for PPI in hospital discharge letters. Eur J Clin Pharmacol. 2010; 66:1265–71.
Ahrens D, Behrens G, Himmel W, Kochen MM, Chenot JF. Appropriateness of proton pump inhibitor recommendations at hospital discharge and continuation in primary care. Int J Clin Pract. 2012;66:767-73.
Eurich, DT, Sadowski, CA, Simpson, SH, Marrie, TJ, Majumdar SR. Recurrent community-acquired pneumonia in patients starting acid-suppressing drugs. Am J Med. 2010; 123:47-53.
Oh AL, Tan AG, Phan HS, Lee BC, Jumaat N, Chew SP, et al. Indication of acid suppression therapy and predictors for the prophylactic use of proton pump inhibitors vs. histamine-2 receptor antagonists in a Malaysian tertiary hospital. Pharm Pract. 2015;13:633.
Yachimski PS, Farrell EA, Hunt DP, Redi AE. Proton pump inhibitors for prophylaxis of nosocomial upper gastrointestinal tract bleeding. effect of standardized guidelines on prescribing practice. Arch Intern Med. 2010;170:779-83.
Akram F, Huang Y, Huggan PJ, Merchant RA. Proton pump inhibitors: Are we still prescribing them without valide indicatons? Australas Med J. 2014;7:465-70.
Eid SM,Boueiz A, Paranji S,Mativo C,Landis R,Abougergi MS. Patterns and predictors of proton pump inhibitor overuse among academic and non-academic hospitalists. Intern Med. 2010;49:2561-8.
Barletta JF, Sclar DA. Use of Proton pump inhibitors for the provision of stress ulcer prophylaxis: clinical and economic consequences. PharmacoEconomics. 2014; 32:5–13.
Ladd, AM, Panagopoulos, G, Cohen, J, Mar, N, Graham R. Potential costs of inappropriate use of proton pump inhibitors. Am J Med Sci. 2014;347:446-51.
Afif W, Alsulaiman R, Martel M, Barkun AN. Predictors of inappropriate utilization of intravenous proton pump inhibitors. Aliment Pharmacol Ther. 2007;25:609-15.
Craig DG, Thimappa R, Anand V, Sebastian S. Inappropriate utilization of intravenous proton pump inhibitors in hospital practice--a prospective study of the extent of the problem and predictive factors. QJM. 2010;103:327-35.
Hoover JG, Schumaker AL, Franklin KJ. Use of intravenous proton-pump inhibitors in a teaching hospital practice. Dig Dis Sci. 2009;54:1947-52.
Bertakis KD,Azari R,Helms LJ,Callahan EJ,Robbins JA. Gender differences in the utilization of health care services. J Fam Pract. 2000;49:147-52.
Pham CQ, Regal RE, Bostwick TR, Knauf KS. Acid suppressive therapy use on an inpatient internal medicine service. Ann Pharmacother. 2006;40: 1261–6.
Hussain S, Stefan M, Visintainer P, Rothberg M. Why do physicians prescribe stress ulcer prophylaxis to general medicine patients? South Med J. 2010;103: 1103–10.
Heidelbaugh, JJ, Inadomi JM. Magnitude and economic impact of inappropriate use of stress ulcer prophylaxis in non-ICU hospitalized patients. Am J Gastroenterol. 2006;101:2200–05.
Wohlt PD, Hansen LA, Fish JT. Inappropriate continuation of stress ulcer prophylactic therapy after discharge. Ann Pharmacother. 2007;41: 1611–6.
Heidelbaugh JJ, Goldberg KL, Inadomi JM. Magnitude and economic effect of overuse of antisecretory therapy in the ambulatory care setting. Am J Manag Care.2010;16: e228-34.
Zink DA, Pohlman M, Barnes M, Cannon ME. Long-term use of acid suppression started inappropriately during Hospitalization. Aliment Pharmacol Ther. 2005;21: 1203–9.
Direitos de Autor (c) 2017 Medicina Interna
Este trabalho encontra-se publicado com a Licença Internacional Creative Commons Atribuição 4.0.
Direitos de Autor (c) 2023 Medicina Interna