title: The use of proton pump inhibitors in an Italian hospital: focus on oncologic and critical non-ICU patients.
abstract: BACKGROUND
  Proton pump inhibitors (PPIs) are among the most misused drugs both at the community and hospital level. Recently, possible risks have been underscored, suggesting the importance of limiting PPI use to proven indications.
  
  
  OBJECTIVE
  To survey the appropriateness of PPI use in a University hospital in Italy. Setting Azienda Ospedaliera Universitaria Policlinico 'P. Giaccone', in Palermo, Italy.
  
  
  METHODS
  A one day-observational study, reviewing patients' medical records to identify treatments with PPIs and the indications for their use. After discharge, a subgroup of the cohort was followed up to assess the continuation of therapy at home. Appropriateness was evaluated according to the indications stated in the official product information sheet and supported by the AIFA notes.
  
  
  METHODS
  Prevalence and appropriateness of PPI use in the hospital and after discharge.
  
  
  RESULTS
  In the index day 62.9 % of 343 evaluable patients received a PPI. In only 29.1 % of these, the treatment could be considered appropriate. The most frequent reasons for inappropriate treatment were stress ulcer prophylaxis in low risk patients and unwarranted gastro-protection in drug treated patients. 30.9 % of patients received PPIs for uncertain indications: of these, 25.7 % were "critical" patients admitted in non-ICU wards. Furthermore, as much as 88.2 % of anticancer drug treated patients received PPIs as gastroprotective agents. At discharge 48.6 % of patients received a prescription to continue PPI therapy at home and 75.9 % of the 83 followed up patients were found to be still taking these drugs after on average 3 months from discharge.
  
  
  CONCLUSIONS
  This study confirms a high proportion of inappropriate PPI therapy into the hospital that translates in a prolonged unnecessary administration in the community setting. Further studies are needed to assess the cost-effectiveness of PPI therapy in subgroups of patients at moderate risk for gastric complications to optimize current guidelines.
authors: Clinical Pharmacology Unit, Department of Hospital General Services, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", via del Vespro 129, 90127, Palermo, Italy. maria.meli@unipa.it.
authors: Maria
authors: M
authors: Meli
authors: Clinical Pharmacology Unit, Department of Hospital General Services, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", via del Vespro 129, 90127, Palermo, Italy.
authors: Maria Pia
authors: MP
authors: Raffa
authors: Department of Biopathology and Medical Biotechnology, University of Palermo, Policlinico "P. Giaccone", via del Vespro 129, 90127, Palermo, Italy.
authors: Renato
authors: R
authors: Malta
authors: Clinical Pharmacology Unit, Department of Hospital General Services, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", via del Vespro 129, 90127, Palermo, Italy.
authors: Ilaria
authors: I
authors: Morreale
authors: Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", via del Vespro 129, 90127, Palermo, Italy.
authors: Luigi
authors: L
authors: Aprea
authors: Clinical Pharmacology Unit, Department of Hospital General Services, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", via del Vespro 129, 90127, Palermo, Italy.
authors: Natale
authors: N
authors: D'Alessandro
mesh_terms: D000328:Adult; D000368:Aged; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007558:Italy; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D013276:Stomach Ulcer / Q000517:prevention & control
chemical_list: D054328:Proton Pump Inhibitors
keywords: Drug utilization; Hospital; Italy; Proton pump inhibitors; Therapeutic appropriateness