Proton pump inhibitor formulary considerations in the acutely ill. Part 2: Clinical efficacy, safety, and economics.
OBJECTIVE
To review, using an evidence-based approach, the clinical efficacy, safety, and cost-effectiveness of proton pump inhibitors (PPIs) for treatment of common acid peptic disorders in the acutely ill and provide clinicians with guidance when making hospital formulary decisions with this class of agents.


METHODS
MEDLINE (1966-May 2005) and the Cochrane Library databases were searched using the key words proton pump inhibitor, acid suppression, peptic ulcer disease, gastrointestinal bleeding, stress ulcer prophylaxis, critical care, safety, and cost-effectiveness. Bibliographies of cited references were reviewed, and a manual search of abstracts from recent gastroenterology, critical care, and surgery scientific meetings was completed.


METHODS
All articles identified from the data sources were evaluated, and all information deemed relevant was included for this review.


RESULTS
PPIs have become a mainstay for acute acid suppression in hospitalized patients. Various commercially available PPI products are available either enterally or parenterally for administration to patients unable to swallow a tablet or capsule. The results of studies comparing the clinical efficacy of different PPI dosage forms and routes of administration, safety considerations, and cost-effectiveness analyses are among the factors to consider when making formulary decisions for this class of drugs.


CONCLUSIONS
While the introduction of new PPI products has expanded the therapeutic options for acid suppression in acutely ill patients, a number of unresolved questions remain surrounding the interchangeability of these products, the clinical significance of one PPI formulation over the other, and how oral/enteral therapy should be used as step-down therapy after parenteral therapy.
Devlin
John W
JW
School of Pharmacy, Northeastern University; Medical Intensive Care Unit, Tufts-New England Medical Center, Boston, MA 02115-5000, USA. j.devlin@neu.edu
Welage
Lynda S
LS
Olsen
Keith M
KM
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000208:Acute Disease; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D002214:Capsules; D006801:Humans; D064747:Lansoprazole; D009853:Omeprazole / Q000031:analogs & derivatives / Q000627:therapeutic use; D010437:Peptic Ulcer / Q000188:drug therapy* / Q000191:economics; D054328:Proton Pump Inhibitors; D013607:Tablets
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D002214:Capsules; D054328:Proton Pump Inhibitors; D013607:Tablets; D064747:Lansoprazole; D009853:Omeprazole