The use of proton pump inhibitors in selected public hospital intensive care units in Johannesburg

Abstract

Stress ulcer prophylaxis (SUP) is an important part of management of critically ill patients in Intensive Care Unit (ICU). However inappropriate use of these drugs has important clinical implications such as ventilator-associated pneumonia (VAP) and gastrointestinal tract (GIT) infections to name a few. Strict adherence to guidelines is the corner stone to gaining maximal desired clinical effect with minimal adverse events. The overuse of proton pump inhibitors (PPIs) as SUP is a rapidly growing problem internationally. In Chris Hani Baragwanath Academic Hospital (CHBAH), Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Helen Joseph Hospital (HJH) there are no studies that have been conducted to investigate this. The aim of this study was to describe the use of PPIs in ICU patients at CHBAH, CMJAH and HJH over a three-month period. A retrospective, descriptive, contextual study design was used. Data were collected from ICU charts of adult patients admitted to CHBAH, CMJAH and HJH ICUs that fulfilled the inclusion criteria. Data were collected over a three-month period. A total of 174 patients were included in the study. Of these patients 156 were on SUP, 95 (60.9%) were appropriately started on SUP and 61 (39.1%) were inappropriately on SUP. This shows overuse of SUP. The number of patients that actually qualified for SUP according to the ASHP guidelines was 113. In that group of patients only 32 (28.3%) were on PPIs and the remainder of the patients 81 (71.7%) were either on other agents or were not on any SUP, reflecting an underuse of PPIs. Our study found inappropriate overuse of SUP according to the ASHP guidelines, however there were patients who qualified for SUP but were not on SUP. In the group of patients that were appropriately on SUP, a large number of them were on other agents and not PPIs even though it is the drug of choice.