Lansoprazole, ranitidine, and metoclopramide: comparison of practice patterns at 4 level III NICUs within one healthcare system.
OBJECTIVE
Evidence is needed to guide NICU use of lansoprazole (Prevacid), ranitidine (Zantac), and metoclopramide (Reglan). As a step toward that goal, we conducted a historic cohort analysis of all patients who received any of these medications in 4 Intermountain Healthcare NICUs during the year 2006.


METHODS
Data were obtained from all patients admitted between January 1 and December 31, 2006, to any of 4 Intermountain Healthcare NICUs.


METHODS
This was a retrospective descriptive design.


METHODS
Data were obtained from electronic pharmacy records and electronic medical records. The NICUs involved were blinded and included McKay-Dee Hospital Center, Ogden, Utah; LDS Hospital, Salt Lake City, Utah; Utah Valley Regional Medical Center, Provo, Utah; and Dixie Regional Medical Center, St George, Utah.


RESULTS
Although the demographics of the patients at the 4 centers were similar, significant differences were seen among the centers in drug use patterns. Lansoprazole use ranged from a high of 17% of patients in one center to a low of 7% of patients in another. Ranitidine use ranged from 9% in one center to 1% in another. Metoclopramide use ranged from 9% of patients in one center to <1% in another.


CONCLUSIONS
The extreme variability among the centers in use patterns of these 3 medications suggests lack of an adequate evidence base to guide practice and indicates that case controlled studies or random controlled trials are needed to devise a consistent evidence-based approach.
Barney
Cindy K
CK
Intermountain Healthcare, McKay-Dee Hospital Center, Ogden, Utah 84403, USA. ckbarney@imail.org
Baer
Vickie L
VL
Scoffield
Scott H
SH
Lambert
Diane K
DK
Cook
Mike
M
Christensen
Robert D
RD
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D016903:Drug Monitoring / Q000706:statistics & numerical data*; D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D019983:Guideline Adherence; D006764:Hospitals, Community / Q000458:organization & administration; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D064747:Lansoprazole; D008499:Medical Records / Q000706:statistics & numerical data*; D008787:Metoclopramide / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011899:Ranitidine / Q000627:therapeutic use*; D012189:Retrospective Studies; D014589:Utah / Q000453:epidemiology
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D011899:Ranitidine; D008787:Metoclopramide