Inappropriate Use of Acid Suppression Therapy in Geriatric Patients Admitted Under Teaching Service on General Medical Floor

Abstract

Purpose: Acid suppression therapy (AST) is one of the most commonly prescribed classes of medications in hospitalized patients. There has been increased use of this medication class over time among hospitalized patients, which might be due to a perception that AST lacks drug interactions and adverse effects. However, proton pump inhibitor (PPI) has been associated with an increased risk of infections such as Clostridium difficile colitis, colonization of MRSA and VRE. Drug clearance decrease with ago and increase the risk of drug interactions. Objective of our study was to estimate inappropriate use of AST in hospitalized geriatric patients and to create physician awareness of appropriate indications of AST. Methods: Medical records of 817 patients admitted under medical teaching service between July 1, 2012, and December 31, 2012, were reviewed. Patients aged older than 65 years who were started on AST in the hospital were included. Patients on AST before admission, AST not given during hospitalization, and surgical and ICU patients were excluded. Data was analyzed using SPSS version 19 (IBM Corp, Armonk, NY). Significant tests of equality of two proportions were carried out using the two tail Fisher's exact test using GraphPad software (GraphPad Software, La Jolla, CA). Student's t-test was used for comparing means of continuous variables. The study was approved by Institutional Review Board (IRB). Results: Among 355 patients who met the inclusion criteria, AST was indicated in 125 (35%) patients and not indicated in 230 (65%) patients. PPI was the most common group of medicine prescribed (92%). Most common route was PO (90%). The most common indication for AST was prophylaxis against NSAID-induced gastritis (54%). Twenty nine (13%) patients who didn't have any indication were discharged on AST. Conclusion: Our study showed that there is a widespread use of AST medications among general medical patients, even in geriatric age group. Our results were similar to other studies done previously in adult patients. Physicians need more awareness of the appropriate indications for AST, rather than writing blanket orders for GI prophylaxis for every patient being admitted to the hospital.