title: Intravenous pantoprazole utilization in a level 1 trauma center.
abstract: BACKGROUND
  In recent years there has been a rapid increase in the use of proton pump inhibitors. Our institution has recently had several shortages of IV pantoprazole, each lasting 7-10 days. The purpose of our study was to evaluate in-patient usage of IV pantoprazole. We hypothesized that hospitalized patients with upper gastrointestinal bleeding (GIB) or risk for stress ulcers inappropriately received IV pantoprazole based on current literature.
  
  
  METHODS
  This was a retrospective study of 165 consecutive in-patients identified as receiving pantoprazole from December 2004 to March 2005. Only patients receiving IV pantoprazole were included (n = 78). Data collected included demographics, indication and dosing of pantoprazole, admitting team (surgery vs. medicine), and risk factors for stress ulcers.
  
  
  RESULTS
  Our study population had a mean age of 54 +/- 17 years and 62% were male. Overall, 45% (35/78) of patients receiving IV pantoprazole had an appropriate indication, and 19% (15/78) received the correct dose. Of the 78 patients, 43 (55%) were treated with pantoprazole for stress ulcer prophylaxis (SUP), and 35 (45%) patients were treated for GIB. We found that none of the 43 patients treated for SUP had an appropriate indication for pantoprazole, but all of the patients with GIB (35) had an appropriate indication. Of the 35 patients treated for GIB with pantoprazole, only 40% (14/35) received the correct dose. In all cases of incorrect dosing, the patients were underdosed.
  
  
  CONCLUSIONS
  Pantoprazole is not being prescribed appropriately for stress ulcer prophylaxis in our patient population. Even in patients appropriately receiving pantoprazole the majority were prescribed an incorrect dose. Appropriate indications and dosing of pantoprazole could eliminate the shortages seen at our institution.
authors: Surgery/Trauma Critical Care, Detroit Receiving Hospital, 4201 St. Antoine Blvd, Detroit, Michigan, 48201, USA. dedelman@med.wayne.edu
authors: David A
authors: DA
authors: Edelman
authors: Krupa R
authors: KR
authors: Patel
authors: James G
authors: JG
authors: Tyburski
authors: Lisa G Hall
authors: LG
authors: Zimmerman
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008508:Medication Errors; D008875:Middle Aged; D000077402:Pantoprazole; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers; D016896:Treatment Outcome
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D000077402:Pantoprazole
references: Cochrane Database Syst Rev. 2004;(3):CD002094
references: 15266462
references: Clin Gastroenterol Hepatol. 2005 Dec;3(12):1207-14
references: 16361046
references: Aliment Pharmacol Ther. 1993 Dec;7(6):589-96
references: 7909240
references: Ann Intern Med. 2003 Nov 18;139(10):843-57
references: 14623622
references: Gut. 1994 Apr;35(4):455-60
references: 8174980
references: Am J Health Syst Pharm. 2004 Mar 15;61(6):588-96
references: 15061430
references: Aliment Pharmacol Ther. 2002 Jun;16(6):1137-42
references: 12030956
references: Arch Fam Med. 2000 Apr;9(4):385-8
references: 10776369
references: Am J Gastroenterol. 2001 Jul;96(7):2058-65
references: 11467632
references: Crit Care Med. 2004 Oct;32(10):2008-13
references: 15483408
references: Aliment Pharmacol Ther. 2007 Mar 1;25(5):609-15
references: 17305762
references: Ann Pharmacother. 2005 Nov;39(11):1844-51
references: 16204393
references: J Clin Pharm Ther. 2000 Oct;25(5):333-40
references: 11123484
references: Aliment Pharmacol Ther. 2004 Dec;20(11-12):1241-51
references: 15606386
references: Crit Care Med. 2002 Jun;30(6 Suppl):S365-8
references: 12072663
references: Crit Care Med. 2002 May;30(5):1118-22
references: 12006811
references: N Engl J Med. 1994 Feb 10;330(6):377-81
references: 8284001
references: Am J Health Syst Pharm. 1999 Feb 15;56(4):347-79
references: 10690219
references: Ann Intern Med. 1987 Apr;106(4):562-7
references: 3548524
references: Gut. 1996 Nov;39(5):649-53
references: 9026477
references: Am J Gastroenterol. 1999 Feb;94(2):351-7
references: 10022628
references: Am J Gastroenterol. 1995 May;90(5):708-12
references: 7733073
references: N Engl J Med. 1998 Jun 25;338(26):1924-5
references: 9643992
references: Am J Gastroenterol. 2004 Jul;99(7):1233-7
references: 15233659
references: Am J Gastroenterol. 2006 Oct;101(10):2206-8
references: 17032184
references: Cochrane Database Syst Rev. 2006 Jan 25;(1):CD002094
references: 16437441
references: Aliment Pharmacol Ther. 1996 Aug;10(4):557-61
references: 8853759
references: Aliment Pharmacol Ther. 2005 May 15;21(10):1203-9
references: 15882240
references: N Engl J Med. 1998 Mar 19;338(12):791-7
references: 9504939
references: Crit Care Med. 2002 Jun;30(6 Suppl):S356-61
references: 12072661
references: Ann Pharmacother. 2005 Oct;39(10):1667-77
references: 16118266
references: Scand J Gastroenterol Suppl. 1990;178:85-92
references: 1980549