title: Guidelines for proton pump inhibitor prescriptions in paediatric intensive care unit.
abstract: Background Stress ulcer prophylaxis (SUP) is recommended in some situations to prevent upper gastrointestinal bleeding and is a component of standard care for patients admitted to the intensive care unit (ICU). Proton pump inhibitors (PPIs), already among the most widely prescribed drug classes, are being increasingly used. Objective To describe PPI prescribing patterns and their changes after the dissemination of guidelines. Setting Paediatric ICU (PICU), Robert-Debré Teaching Hospital, Paris, France, which admits about 800 patients annually, from full-term neonates to 18-year-olds. Method Prospective observational study with two 6-week observation periods (July-August and September-October, 2013), before and after dissemination in the PICU of PPI prescribing guidelines. Main outcome measure Changes in PPI prescribing patterns (prevalence, dosage, and indication) after the guidelines. Results The number of patients admitted to the PICU was 77 (mean age 4.6 years [range 1 day-18 years]) before and 70 (mean age 3.8 years [range 1 day-17 years]) after the guidelines. During both periods, SUP was the most common reason for PPI prescribing. The proportion of patients prescribed PPIs dropped significantly, from 51% before the guidelines to 30% after the guidelines (p < 0.001). Mean daily dosage also decreased significantly, from 1.5 mg/kg/(range 0.5-4.4) to 1.1 mg/kg (range 0.7-1.8) (p < 0.002). None of the patients experienced upper gastrointestinal bleeding during either period. Conclusion Off-label PPI prescribing for SUP was common in our PICU. The introduction of guidelines was associated with a significant decrease in PPI use and dosage. This study confirms that guidelines can change PPI prescribings patterns in paediatric practice.
authors.affiliation: Département de Pharmacie, Hôpital Robert-Debré, AP-HP, 48 boulevard Sérurier, 75395, Paris Cedex 19, France.
authors.forename: P
authors.initials: P
authors.lastname: Joret-Descout
authors.affiliation: Réanimation et surveillance continue pédiatrique, Hôpital Robert-Debré, AP-HP, Paris, France.|Université Paris 7- Paris Diderot, Paris, France.|INSERM U1141, Hôpital Robert-Debré, AP-HP, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Dauger
authors.affiliation: Gastroentérologie pédiatrique, Hôpital Robert-Debré, AP-HP, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Bellaiche
authors.affiliation: Département de Pharmacie, Hôpital Robert-Debré, AP-HP, 48 boulevard Sérurier, 75395, Paris Cedex 19, France.|Pharmacie Clinique, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.|Laboratoire Education et Pratiques de Santé, EA 3412, Université Paris 13, Sorbonne Paris Cité, Bobigny, France.
authors.forename: O
authors.initials: O
authors.lastname: Bourdon
authors.affiliation: Département de Pharmacie, Hôpital Robert-Debré, AP-HP, 48 boulevard Sérurier, 75395, Paris Cedex 19, France. sonia.prot-labarthe@aphp.fr.|Laboratoire Education et Pratiques de Santé, EA 3412, Université Paris 13, Sorbonne Paris Cité, Bobigny, France. sonia.prot-labarthe@aphp.fr.|INSERM, U1123, ECEVE, Paris, France. sonia.prot-labarthe@aphp.fr.
authors.forename: S
authors.initials: S
authors.lastname: Prot-Labarthe
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000592:standards*; D008297:Male; D056687:Off-Label Use / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*
chemical_list: D054328:Proton Pump Inhibitors
keywords: Drug prescriptions; France; Guidelines; Intensive care unit; Off-label prescribing; Pediatrics; Proton pump inhibitors