The Pattern of Intravenous Proton-Pump Inhibitor Utilization at an Academic Medical Center in Riyadh, Saudi Arabia

Overview

Journal J Res Pharm Pract

Date 2021 Jan 25

PMID 33489984

Citations 4

Authors

Yahya Ali Mohzari

Ahmed Alsaegh

Syed Mohammed Basheeruddin Asdaq

Sulafah N Al Shanawani

Amani A Albraiki

Amal Bagalb

Affiliations

Soon will be listed here.

Abstract

Objective: This study was designed to evaluate the extent of inappropriate utilization of intravenous proton-pump inhibitors (IV-PPIs) and its financial burden in a Middle Eastern tertiary care university hospital.

Methods: This was an observational, retrospective, cross-sectional study carried out in King Saud University Medical City, Riyadh, Saudi Arabia. During a study period of 6 consecutive weeks, all hospitalized adult patients (age ≥18) who received IV-PPI selected and mapped with their indications. The patient indications analyzed in comparison with the appropriate indications developed based on the evidence from published literature and guidelines.

Findings: A total of 347 patients were identified, with a mean age of 51.5 years, of which 51.9% were male. Of all the patients who received IV-PPIs, 251 (72.3%), 66 (19%), and 30 (8.7%) received for stress ulcer prophylaxis (SUP), peptic ulcer disease (PUD) or gastroesophageal reflux diseases (GERDs), and upper gastrointestinal bleeding, respectively. Overall, only 110 (31.7%) of the 347 patients received IV-PPIs appropriately. The patients with SUP showed the highest percentage of inappropriate use of IV-PPI (80.59%) compared to PUD/GERD (19%). The total cost of inappropriate prescription of IV-PPI was 585,167 Saudi Riyal (SAR) (156,044 USD).

Conclusion: There is a high tendency of IV-PPI's inappropriate prescription in our hospital setting. This large-scale inappropriate prescription of IV-PPI in the hospital setting not only may lead to increased financial burden but also expose patients to number of undesired effects.

Citing Articles

Practices and knowledge of community pharmacists towards the use of proton pump inhibitors: a cross-sectional study in Jordan.

Gharaibeh L, Alameri M, Al-Hawamdeh M, Daoud E, Atwan R, Lafi Z BMJ Open. 2025; 15(2):e085589.

PMID: 39922594 PMC: 11808909. DOI: 10.1136/bmjopen-2024-085589.

Predictive Factors Associated with Inappropriate Intravenous Proton Pump Inhibitors Use in Hospitalized Patients: A Case-Control Study.

Khoury N, Stepensky D, Abu Freha N, Mahamid M, Khoury T, Mari A Medicina (Kaunas). 2025; 61(1).

PMID: 39858992 PMC: 11767144. DOI: 10.3390/medicina61010010.

Knowledge and Attitudes Regarding the Inappropriate Use of Proton Pump Inhibitors Among Students of Umm Al-Qura University in Saudi Arabia: A Cross-Sectional Study.

Alhazmi A, Alamri A, Alayyafi T, Allehaibi L, Aldurdunji M Cureus. 2024; 16(10):e71282.

PMID: 39534847 PMC: 11554437. DOI: 10.7759/cureus.71282.

Use of potentially inappropriate medication for elderly patients in tertiary care hospital of Riyadh, Saudi Arabia.

Alanazi S, Al Amri A, Almuqbil M, Alroumi A, Gamal Mohamed Alahmadi M, Obaid Ayesh Alotaibi J Saudi Pharm J. 2024; 32(4):102015.

PMID: 38497086 PMC: 10940805. DOI: 10.1016/j.jsps.2024.102015.

Evaluation of Proton Pump Inhibitors Prescribing Among Hospitalized Patients: A Cross-Sectional Study.

Abukhalil A, Ali O, Saad A, Falana H, Al-Shami N, Naseef H Int J Gen Med. 2023; 16:141-150.

PMID: 36659914 PMC: 9843499. DOI: 10.2147/IJGM.S396202.

References

Pang S, Graham D . A clinical guide to using intravenous proton-pump inhibitors in reflux and peptic ulcers. Therap Adv Gastroenterol. 2010; 3(1):11-22. PMC: 3002568. DOI: 10.1177/1756283X09352095. View

Yadlapati R, Kahrilas P . When is proton pump inhibitor use appropriate?. BMC Med. 2017; 15(1):36. PMC: 5319103. DOI: 10.1186/s12916-017-0804-x. View

Cheung K, Leung W . Gastrointestinal bleeding in patients on novel oral anticoagulants: Risk, prevention and management. World J Gastroenterol. 2017; 23(11):1954-1963. PMC: 5360636. DOI: 10.3748/wjg.v23.i11.1954. View

Leontiadis G, Sharma V, Howden C . Proton pump inhibitor therapy for peptic ulcer bleeding: Cochrane collaboration meta-analysis of randomized controlled trials. Mayo Clin Proc. 2007; 82(3):286-96. DOI: 10.4065/82.3.286. View

Alsultan M, Mayet A, A Malhani A, Alshaikh M . Pattern of intravenous proton pump inhibitors use in ICU and Non-ICU setting: a prospective observational study. Saudi J Gastroenterol. 2010; 16(4):275-9. PMC: 2995097. DOI: 10.4103/1319-3767.70614. View

Grube R, May D . Stress ulcer prophylaxis in hospitalized patients not in intensive care units. Am J Health Syst Pharm. 2007; 64(13):1396-400. DOI: 10.2146/ajhp060393. View

Kelly O, Dillane C, Patchett S, Harewood G, Murray F . The Inappropriate Prescription of Oral Proton Pump Inhibitors in the Hospital Setting: A Prospective Cross-Sectional Study. Dig Dis Sci. 2015; 60(8):2280-6. DOI: 10.1007/s10620-015-3642-8. View

Rotman S, Bishop T . Proton pump inhibitor use in the U.S. ambulatory setting, 2002-2009. PLoS One. 2013; 8(2):e56060. PMC: 3572154. DOI: 10.1371/journal.pone.0056060. View

Ogasawara O, Kojima T, Miyazu M, Sobue K . Impact of the stress ulcer prophylactic protocol on reducing the unnecessary administration of stress ulcer medications and gastrointestinal bleeding: a single-center, retrospective pre-post study. J Intensive Care. 2020; 8:10. PMC: 6966877. DOI: 10.1186/s40560-020-0427-8. View

10.

. ASHP Therapeutic Guidelines on Stress Ulcer Prophylaxis. ASHP Commission on Therapeutics and approved by the ASHP Board of Directors on November 14, 1998. Am J Health Syst Pharm. 2000; 56(4):347-79. DOI: 10.1093/ajhp/56.4.347. View

11.

Lai P, Wong Y, Low Y, Lau H, Chin K, Mahadeva S . Unexplained abdominal pain as a driver for inappropriate therapeutics: an audit on the use of intravenous proton pump inhibitors. PeerJ. 2014; 2:e451. PMC: 4081131. DOI: 10.7717/peerj.451. View

12.

Kaplan G, Bates D, McDonald D, Panaccione R, Romagnuolo J . Inappropriate use of intravenous pantoprazole: extent of the problem and successful solutions. Clin Gastroenterol Hepatol. 2005; 3(12):1207-14. DOI: 10.1016/s1542-3565(05)00757-3. View

13.

Richardson P, Hawkey C, Stack W . Proton pump inhibitors. Pharmacology and rationale for use in gastrointestinal disorders. Drugs. 1998; 56(3):307-35. DOI: 10.2165/00003495-199856030-00002. View

14.

Hoover J, Schumaker A, Franklin K . Use of intravenous proton-pump inhibitors in a teaching hospital practice. Dig Dis Sci. 2008; 54(9):1947-52. DOI: 10.1007/s10620-008-0568-4. View

15.

Craig D, 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(5):327-35. DOI: 10.1093/qjmed/hcq019. View

16.

Guda N, Noonan M, Kreiner M, Partington S, Vakil N . Use of intravenous proton pump inhibitors in community practice: an explanation for the shortage?. Am J Gastroenterol. 2004; 99(7):1233-7. DOI: 10.1111/j.1572-0241.2004.30894.x. View

17.

Friedenberg F, Hanlon A, Vanar V, Nehemia D, Mekapati J, Nelson D . Trends in gastroesophageal reflux disease as measured by the National Ambulatory Medical Care Survey. Dig Dis Sci. 2009; 55(7):1911-7. DOI: 10.1007/s10620-009-1004-0. View

18.

Nguyen P, Tamaz R . Inappropriate Prescription of Proton Pump Inhibitors in a Community Setting. Can J Hosp Pharm. 2018; 71(4):267-271. PMC: 6118833. View