Relevance of proton pump inhibitors prescriptions in a tertiary care hospital in Lebanon

Abstract

Background and study aims: Studies have shown that PPIs are frequently used in an inappropriate way, above the standard doses, and against the recommendations, leading to adverse events like malabsorption problems, community acquired pneumonia, hip fractures and Clostridium difficile colitis. In Lebanon only one study about the out-patient use of PPI was done in community pharmacies, but in-patient prescription studies are inexistent. Our study will evaluate the use of PPIs in a hospital setting in Lebanon and will compare it to international recommendations.

Patients and methods: A cross-sectional study, conducted in a university hospital in Lebanon (CHU NDS) between June and November 2018, included 186 randomly selected Lebanese inpatient adults.

Results: Less than half of the participants (46.8%) received a PPI for the adequate indication and 83.9% received the adequate PPI molecule, whereas only 9.2% received the adequate dose. The rate of PPI misuse was higher in the surgery ward (59.6%) than in the medicine department (40.4%) (Cardiology, internal medicine, neurology, pneumology, nephrology, infectious diseases, gastro-enterology, rheumatology). Concerning age, 56.3% of the ≥ 65 years old patients were taking PPI for the right indication. However, among those who are < 65 years old, only 43.7% of the prescriptions were recommended. Also adequate PPI indication and adequate choice of drug was mainly noticed in patients having GI history or taking antiplatelet therapy.

Conclusion: Our study has shown that a significant amount of PPIs was prescribed inadequately leading to a need to re-evaluate or adjust the use of PPIs among Lebanese physicians.

Keywords: Hospital; Indications; Prescription; Proton pump inhibitors.