Inappropriate use of acid suppression therapy in Internal Medicine wards of a tertiary care teaching Hospital.

Abstract

Objective: To assess appropriateness of prescription of acid suppressive therapy (AST) in Internal Medicine ward in a tertiarycare hospital. Methods: In this prospective observational study , weincluded all those patientswho were started on AST after admission in the internal medicine ward in a tertiary care hospital in Hyderabad ,Sindh ,Pakistan from May 1 to July 31, 2013 . All those patientswere excluded from the study who were alreadyon the AST therapy. Details were taken regarding age, sex, primary diagnosis, other morbidity, drug used for AST and indication for AST on a specifically designed proforma. The appropriatenessof AST was determined by widely accepted Food and drug authority (FDA) indications and American society of health system pharmacist (ASHP) guidelines. Results: We included300 Patients in our study. All patients, in our study, were given AST at the time of admission tothe medicine ward. 133 (44.33%) Patients were male and 167 (55.66%) were female, their mean age was 43.91±18.58 (mean ± SD). 53 (17.6%) Patients had a FDA approved indication.51 (17%) Patients received AST therapy for SUP (stress ulcer prophylaxis) Out of that 7 (2.3%) had an absolute indication for SUP, 44(14.8%) had 2 or more relative indications for SUP . 196 (65.3%)received AST without any appropriate indication. Omeparzolewas themost frequently used AST (55%), followed byranitidine (45%) Conclusion:Use of AST is mostly inappropriate inInternal medicinewards.Implementation of institutional protocols, evidence based medicine teaching during residency training, and frequent review of therapy by the attending consultant during ward rounds may be helpfulto promote appropriate use of AST in medicine wards.