Irrational use of proton pump inhibitors in general practise

Proton pump inhibitors (PPI) are widely used among general practitioners (GP) and hospital doctors alike as a first-line agent for the management of various approved conditions. However, PPIs do have an established side-effect profile that can be over looked when prescribing these agents outside of their Food Drug Administration (FDA) indications.

The aim of this audit is to establish that PPIs are often prescribed without any clear documented indication as to why, particularly in the elderly population, despite multiple previous studies conducted which showed an over-use of these medicines.

We conducted a retrospective observational study of the patients admitted to an acute hospital in Ireland in February 2018. A cohort of patient charts were pulled from medical records and reviewed. Medical notes, GP letters, discharge summaries and prescriptions were reviewed in order to establish the primary indication for PPI prescription.

One hundred seventy-four (n = 174) inpatient records were randomly assessed during the audit. Of these patients, 85 of them were taking PPIs regularly. 54.7% (n = 46) were prescribed a PPI without any documented indication. 46.4% (n = 39) of these patients were > 75 years of age. 54.7% (n = 46) of patients were prescribed esomeprazole. The commonest indication for prescribing PPIs was to reduce the risk of gastric ulceration associated with NSAID use, which was 68.4% (n = 26) of those who were prescribed a PPI in accordance with guidelines.

Irrational prescribing of PPIs continues both in hospital and in general practise. It is imperative that the side-effects of these medicines are weighed against the benefit and cost effectiveness, especially in the elderly population where polypharmacy remains a substantial concern.