PRESCRIBING PATTERN OF PROTON PUMP INHIBITORS IN THE DEPARTMENT OF GENERAL MEDICINE OF A TERTIARY CARE HOSPITAL

Department of Pharmacy Practice, Faculty of Pharmacy, M.S. Ramaiah University of Applied Sciences, Bangalore, Karnataka, India

ABSTRACT

OBJECTIVES: Utilization of Proton Pump Inhibitors (PPIs) has increased enormously as over the counter (OTC) drugs by general public in India. Also, in current clinical practice, majority of the prescriptions include PPIs for gastric prophylaxis together with antibiotics and analgesics. Medical ignorance and underestimation of the adverse effects (like clostridium difficle infection, nutritional deficiency disorders and fractures etc.,) are the factors underlying such escalated PPI consumption. This scenario prompted us to look into the drug utilization pattern and the appropriateness in utilization of PPIs in a tertiary care hospital.

METHODS: This is a prospective observational study conducted in the Department of General Medicine for a period of 1 year from August 2017 to July 2018 to analyse the prescribing pattern of PPIs. The medication charts of both inpatients and outpatients of General Medicine department was reviewed. Core information such as demographic characteristics, diagnosis, and current medications were recorded. The patients were regularly monitored for drug – drug interactions.

RESULTS: Of 1019 prescriptions, 908 (89%) prescriptions were found to have PPIs. Pantoprazole 749 (82.49%) was the most commonly prescribed PPI followed by esomeprazole 124 (13.66%). The indications for PPI therapy were acute gastroenteritis 103 (11.34%), gastric ulcers 7 (0.77%), gastro esophageal reflux disease 5 (0.55%), gastrointestinal bleeding 3 (0.33%), ulcerative colitis 2 (0.22%), IBD 1(0.11%), esophageal and gastric injury 1(0.11%), gastric erosion 1 (0.11%). PPIs were found to prescribe with antibiotics 681 (75%) followed by non-steroidal anti-inflammatory drugs 179 (19.7%).

CONCLUSIONS: The study showed inappropriateness in prescribing patterns of PPIs leading to increased therapeutic burden and treatment cost. This necessitates formulation of standard therapeutic guidelines for rationalizing the utilization of PPIs.