How appropriately are adults being prescribed proton pump inhibitors - experience of a tertiary care centre

Abstract

Background and Objectives: Proton pump inhibitors (PPIs) are one of the commonest medicines prescribed in recent years as they are highly effective and remarkably safe. However, there is a growing concern that PPIs are being overprescribed and used for poorly defined reasons or for conditions where they are not beneficial. This study was conducted to study the type, duration, indication and appropriateness of PPI use.Methodology: This prospective observational study was conducted in medicine department of K.M.C.H and LSK Hospital, Kishanganj, Bihar, India over1 year from January 2020 to December 2020 including adults visiting our medicine OPD for the first time who were already on PPI therapy. Data was collected by direct interviewing as well as review of previous prescriptions.Results: Total 393 patients were enrolled and assessed for use of PPIs. Mean duration of PPI use was 11.7 ± 6.1 months. More than half (52.7%) had no clear indication, 37.7% had valid indication and 9.7% had a borderline indication. Patients with valid indication were given PPIs for dyspepsia (27.7%), GERD (24.3%), stress ulcer prophylaxis (19.6%) and peptic ulcer (16.2%). Patients without valid indication were given PPIs for anemia (24.6%), NSAIDs (14%) and corticosteroids therapy (12.6%). Similarly, patients with borderline acceptable indication were given PPIs for post endoscopic procedure (39.5%), use of double antiplatelet agents (18.4%) and uninvestigated dyspepsia (18.4%). Only 61.3% were receiving recommended maintenance dose and the rest 38.7% were using high dose. Only 22.9% had undergone upper G.I endoscopy and the rest 77.1% were prescribed long term PPI without a convincing evidence. Conclusion: Doctors should be more thoughtful while prescribing PPIs to provide an appropriate, safe and cost effective advice. Prescription should follow evidence based practice as unnecessary and inappropriate prescribing isn’t cost effective and potentially harmful too.