Introduction: Proton pump inhibitors (PPIs) were until very recently perceived to be safe, effective and inexpensive. As a result they are widely prescribed empirically, beyond their core indications. However dose-dependent adverse reactions increasingly reported include diarrhoea, resistant hypomagnesaemia/hypocalcaemia and interstitial nephritis. Moreover, they are associated with increased rates of vertebral and wrist fractures, and increased C. difficile carriage rate.
Aims: To ascertain the extent and appropriateness of PPR prescribing in patients admitted to the Diabetes and Endocrine medical base ward in the Royal Victoria Infirmary (RVI).
Standards: All PPIs prescribed should have a clear indication, duration for treatment and/or date of review.
Methods: Over an 8 week period, 105 consecutive admissions to Ward 31, RVI were evaluated for i) dose of PPI prescribed (low-dose, standard dose or high dose); ii) identifiable indication from patient history, admissions proforma, pharmacist history, GP referral letters and/or electronic records.
Results: 50/105 patients were taking on a PPI, 20 of whom (40%) had no current clear indication (9 patients low-dose, 10 standard dose, 1 high-dose).
Conclusion: Nineteen percent of new patients admitted to a general medical ward were taking a PPI for no clear indication. When a drug is perceived to be safe, effective and inexpensive, documentation tends to be sparse. Although PPIs cause hypomagnesaemia/hypocalcaemia in only a tiny proportion of patients, they are so widely prescribed that they possibly constitute the most common cause of hypomagnesaemia/hypocalcaemia among hospital inpatients.
Suggestions: PPIs should only be used for their core indications. When a PPI is started, expected duration of therapy and date of review should ideally be established at the outset. Clear record keeping by GPs and hospital doctors is essential. If no indication is found in secondary care, the PPI dose should be reduced at least and the primary care physician informed.