Stress ulcer prophylaxis in an evidence-based analysis of therapy.

Abstract

Abstract The American Society of Health-System Pharmacists (ASHP) therapeutic guidelines on stress ulcer prophylaxis are the first society-based published guidelines. These guidelines were promulgated following a rigorous and formal examination of the published medical literature. This evidence-based medicine approach is crucial for the development of comprehensive scientifically based clinical care. A multidisciplinary team including pharmacy specialists in critical care and drug information, consulting physicians and nurses, and an independent panel of clinical specialists appointed by ASHP prepared and reviewed the guidelines. The guidelines can aid health care professionals in identifying appropriate patients for stress ulcer prophylaxis and selecting cost-effective therapeutic options. The scope of the article includes application of guidelines for patients of all ages following a stressful event, such as trauma or surgery, which would predispose them to stress-induced bleeding. Therapeutic agents evaluated include only those available in the United States, regardless of United States Food and Drug Administration-approved labeling. The article is divided into sections with pertinent issues related to stress ulcer prophylaxis in adults and pediatrics, when plausible. The evidence-based medical guidelines were developed following a comprehensive literature review of each presented issue. Summary data from randomized controlled trials and meta-analyses are presented to validate and strengthen the authors' line of reasoning. A summary and recommendation paragraph follows each major section. The first section evaluates the issues of frequency of bleeding, efficacy of prophylaxis, and risk factors for bleeding in general. The second major area of review includes these same topics as they relate to special populations. Other topics evaluated include the efficacy of prophylactic agents on bleeding prevention and mortality. A separate part evaluates the frequency of nosocomial pneumonia associated with stress ulcer prophylaxis. Therapeutic monitoring, other options for prophylaxis, prevention of recurrent bleeding, discontinuation of prophylaxis, and economic analysis complete the article.