title: Imprudent Gastro-protective Approach in Majority of Specialists' Clinics of a Tertiary Hospital.
abstract: BACKGROUND
  One out of four prescriptions in out-patient departments contains a gastro-protective drug (APUD) - PPI/ H2 Blockers/ Antacids/ Ulcer Protective's. These drugs should be prescribed only when there is a justified indication. To assess the prescriptions of gastro-protective agents for appropriateness and rationality, in a tertiary care hospital setup.
  
  
  METHODS
  It was a cross-sectional observational study conducted from Aug 2013 to Dec 2013 at OPDs of a Tertiary Care Teaching Hospital, Pune. A total of 260 prescriptions containing gastro-protective agents were analysed for appropriateness and rationality. Rationality of drug use was assessed by referring to standard textbooks and guidelines. Cost difference data was analysed by Wilcoxon signed rank test using GraphPad Prism 6.
  
  
  RESULTS
  Most common class of gastro-protective agents was Proton pump inhibitors (PPIs)-73.77% (Pantoprazole & Dexrabeprazole). Only 37.3% prescriptions had an adequate indication for these drugs {GI prophylaxis (29.6%) and Acid Peptic Disease treatment (7.7%)}. Two irrational Fixed dose combinations found in the study were PPI with prokinetic agent (n=65) and Proton Pump Inhibitor + NSAID combination (n=2). Formulation, spelling and strength errors were found with 75 prescribed drugs. Medication instructions were lacking with most of the drugs. Drug interactions with co-prescribed drugs could be anticipated in 79 cases. Injudicious use of anti-peptic ulcer agents significantly increased the cost of prescriptions (p<0.0001).
  
  
  CONCLUSIONS
  Anti-ulcer drugs are overenthusiastically prescribed by all specialties which can predispose to adverse effects, drug interactions, increased cost and even erroneous prescriptions.
authors.affiliation: Associate Professor, Department of Pharmacology, Bharati Vidyapeeth Deemed University Medical College , Pune, Maharashtra, India .
authors.forename: Hardik Rameshbhai
authors.initials: HR
authors.lastname: Patel
authors.affiliation: Resident, Department of Pharmacology, Bharati Vidyapeeth Deemed University Medical College , Pune, Maharashtra, India .
authors.forename: Priti
authors.initials: P
authors.lastname: Dhande
keywords: Anti-ulcer drugs; Prescriptions; Rationality