Lansoprazole, ranitidine, and metoclopramide: comparison of practice patterns at 4 level III NICUs within one...

Evidence is needed to guide NICU use of lansoprazole (Prevacid), ranitidine (Zantac), and metoclopramide (Reglan). As a step toward that goal, we conducted a historic cohort analysis of all patients who received any of these medications in 4 Intermountain Healthcare NICUs during the year 2006.

Data were obtained from all patients admitted between January 1 and December 31, 2006, to any of 4 Intermountain Healthcare NICUs.

This was a retrospective descriptive design.

Data were obtained from electronic pharmacy records and electronic medical records. The NICUs involved were blinded and included McKay-Dee Hospital Center, Ogden, Utah; LDS Hospital, Salt Lake City, Utah; Utah Valley Regional Medical Center, Provo, Utah; and Dixie Regional Medical Center, St George, Utah.

Although the demographics of the patients at the 4 centers were similar, significant differences were seen among the centers in drug use patterns. Lansoprazole use ranged from a high of 17% of patients in one center to a low of 7% of patients in another. Ranitidine use ranged from 9% in one center to 1% in another. Metoclopramide use ranged from 9% of patients in one center to <1% in another.

The extreme variability among the centers in use patterns of these 3 medications suggests lack of an adequate evidence base to guide practice and indicates that case controlled studies or random controlled trials are needed to devise a consistent evidence-based approach.