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INT-003 The use of proton pump inhibitors in hospitalised patients

Background The use of proton pump inhibitors (PPIs) to treat acid-related disorders is increasing worldwide and this raise concerns. Accumulating evidence supports the increased risk of long-term adverse events such as: fractures, C. difficile-associated diarrhoea and pneumonia all associated with chronic PPI use. Purpose Mapping the incidence, indication and duration of PPI therapy in Hungarian inpatients. Quality was assessed in comparison to the official indications and therapeutic guidelines. The number of chronically used medication was also evaluated. Method A point prevalence survey (25 January 2017) was performed to assess PPI use. The study was done in units which use patient-level, daily dose dispensing systems. A special data collection sheet was designed. Data were extracted from patients’ medical records and some questions were clarified by patient interviews. Results In total 29 units participated. On the study day 399 patients were on PPI products, which corresponds to 46.2% (CI: 42.9% to 49.5%) of all inpatients (n=864). Pantoprazol was the dominating PPI, overall 384 patients (96.2%) used it. The average age of PPI users was 69 years (min: 23 years, max: 98 years). The majority of PPI users (344 patients, 86%) were using five or more chronic medications. The use of a PPI was appropriate (used for indications such as peptic ulcer or gastroesophageal reflux disease) for 138 patients (34.6%) and inappropriate (e.g. were initiated because of polypharmacy) for 125 patients (31.3%). For the remaining 126 patients the appropriateness of PPI prescription could not be clearly evaluated (e.g. corticosteroid therapy, low-dose aspirin and clopidogrel therapy). Eighty-four (21%) patients out of the total study population started a PPI treatment in the hospital, post-admission. Twenty-five per cent of patients were treated with a PPI less than 1 year prior to measurement, 34% of patients were treated between 1 and 5 years prior to measurement and 20% of patients were permanent PPI users exceeding 5 years of treatment prior to measurement. Conclusions PPIs were used extensively in hospitalised patients. Only every third patient in the study had a valid condition to use a PPI. The overuse of PPIs may lead to the development of long-term side-effects. Acknowledgements Contributors: Balazs, Hanko, Andras Gyurcsanyi, Istvan Horvath, Denes Kleiner, Eszter Kocsis, Katalin Kovacs, Sarolta Mako, Lilla Ovari, Katalin Csukonyi, Maria Szabo, Ilona Higyisan and Gabriella Diczko.