AIM:To assess the appropriateness of the indication and route of administration of proton-pump-inhibitors (PPIs) and their associated cost impact. METHODS:Data collection was performed prospec-tively during a 6-mo per...AIM:To assess the appropriateness of the indication and route of administration of proton-pump-inhibitors (PPIs) and their associated cost impact. METHODS:Data collection was performed prospec-tively during a 6-mo period on 340 patients who re-ceived omeprazole intravenously during their hospital stay in non-intensive care floors. Updated guidelines were used to assess the appropriateness of the indication and route of administration. RESULTS:Complete data collection was available for 286 patients which were used to assess intravenous (IV) PPIs utilization. Around 88% of patients were receiving PPIs for claimed stress ulcer prophylaxis (SUP) indication; of which,only 17% met the guideline criteria for SUP indication,14% met the criteria for non-steroidal-anti-inflammatory drugs-induced ulcer prophylaxis,while the remaining 69% were identifi ed as having an unjustified indication for PPI use. Theinitiation of IV PPIs was appropriate in 55% of pa-tients. Half of these patients were candidates for switching to the oral dosage form during their hos-pitalization,while only 36.7% of these patients were actually switched. The inappropriate initiation of PPIs via the IV route was more likely to take place on the medical floor than the surgical floor (53% vs 36%,P = 0.003). The cost analysis associated with the appro-priateness of the indication for PPI use as well as the route of administration of PPI revealed a possible saving of up to $17 732.5 and $14 571,respectively. CONCLUSION:This study highlights the over-utili-zation of IV PPIs in non-intensive care unit patients. Restriction of IV PPI use for justified indications and route of administration is recommended.展开更多
Background: Preeclampsia is a hypertensive disorder of pregnancy with a high rate of neonatal and maternal morbidity and mortality. The only definitive treatment is delivery. Through pre-clinical studies, proton pump ...Background: Preeclampsia is a hypertensive disorder of pregnancy with a high rate of neonatal and maternal morbidity and mortality. The only definitive treatment is delivery. Through pre-clinical studies, proton pump inhibitors (PPIs), which are commonly and safely used in pregnancy, have been identified as potential therapeutic agents. Objective: To undertake a systematic review evaluating PPIs in the prevention and/or treatment of preeclampsia and gestational hypertension. Search strategy: Electronic databases were searched from inception to 2018. Search terms included preeclampsia, proton-pump inhibitors, pregnancy-induced hypertension, lansoprazole, rabeprazole, esomeprazole and omeprazole. Selection criteria: Studies were included if they were randomized control trials, case-control or cohort studies on human subjects. Case reports, review articles, opinion pieces and conference abstracts were excluded as well as studies with no or inappropriate control arms. Data collection and analysis: Only one eligible study was identified, so no analyses were able to be performed. Main results: There was only one clinical trial eligible for inclusion. This was a randomized clinical trial investigating the role of PPIs in the treatment of preterm preeclampsia in a high-risk, inpatient setting. This was a negative finding, with no change in the primary outcome of prolongation of gestation between the PPI group and placebo control. Conclusion: There is a scarcity of clinical trials published investigating the therapeutic potential of PPIs for preeclampsia and gestational hypertension. Of the one available study, PPIs were not found to prolong gestation among preterm preeclamptic patients compared to placebo control. In order to further elucidate the clinical potential of PPIs to prevent or treat preeclampsia, further trials are required.展开更多
文摘AIM:To assess the appropriateness of the indication and route of administration of proton-pump-inhibitors (PPIs) and their associated cost impact. METHODS:Data collection was performed prospec-tively during a 6-mo period on 340 patients who re-ceived omeprazole intravenously during their hospital stay in non-intensive care floors. Updated guidelines were used to assess the appropriateness of the indication and route of administration. RESULTS:Complete data collection was available for 286 patients which were used to assess intravenous (IV) PPIs utilization. Around 88% of patients were receiving PPIs for claimed stress ulcer prophylaxis (SUP) indication; of which,only 17% met the guideline criteria for SUP indication,14% met the criteria for non-steroidal-anti-inflammatory drugs-induced ulcer prophylaxis,while the remaining 69% were identifi ed as having an unjustified indication for PPI use. Theinitiation of IV PPIs was appropriate in 55% of pa-tients. Half of these patients were candidates for switching to the oral dosage form during their hos-pitalization,while only 36.7% of these patients were actually switched. The inappropriate initiation of PPIs via the IV route was more likely to take place on the medical floor than the surgical floor (53% vs 36%,P = 0.003). The cost analysis associated with the appro-priateness of the indication for PPI use as well as the route of administration of PPI revealed a possible saving of up to $17 732.5 and $14 571,respectively. CONCLUSION:This study highlights the over-utili-zation of IV PPIs in non-intensive care unit patients. Restriction of IV PPI use for justified indications and route of administration is recommended.
文摘Background: Preeclampsia is a hypertensive disorder of pregnancy with a high rate of neonatal and maternal morbidity and mortality. The only definitive treatment is delivery. Through pre-clinical studies, proton pump inhibitors (PPIs), which are commonly and safely used in pregnancy, have been identified as potential therapeutic agents. Objective: To undertake a systematic review evaluating PPIs in the prevention and/or treatment of preeclampsia and gestational hypertension. Search strategy: Electronic databases were searched from inception to 2018. Search terms included preeclampsia, proton-pump inhibitors, pregnancy-induced hypertension, lansoprazole, rabeprazole, esomeprazole and omeprazole. Selection criteria: Studies were included if they were randomized control trials, case-control or cohort studies on human subjects. Case reports, review articles, opinion pieces and conference abstracts were excluded as well as studies with no or inappropriate control arms. Data collection and analysis: Only one eligible study was identified, so no analyses were able to be performed. Main results: There was only one clinical trial eligible for inclusion. This was a randomized clinical trial investigating the role of PPIs in the treatment of preterm preeclampsia in a high-risk, inpatient setting. This was a negative finding, with no change in the primary outcome of prolongation of gestation between the PPI group and placebo control. Conclusion: There is a scarcity of clinical trials published investigating the therapeutic potential of PPIs for preeclampsia and gestational hypertension. Of the one available study, PPIs were not found to prolong gestation among preterm preeclamptic patients compared to placebo control. In order to further elucidate the clinical potential of PPIs to prevent or treat preeclampsia, further trials are required.
