EC Pharmacology And Toxicology

<Objectives: Proton pump inhibitors are a standard component in the care of critically ill children in PICU, especially for stress ulcer prophylaxis. This study aims to evaluate the prescribing pattern of proton pump inhibitors in PICU and assess appropriateness against proposed guidelines.

Methods: Data of all patients admitted to PICU and received proton pump inhibitors between March 1^st and March 31^st 2023 were retrieved. All patients aged between 1 day and 16 years were included.

Results: 57 prescriptions of proton pump inhibitors were identified, which represented 60% of all patients admitted to PICU. The indication of proton pump inhibitors was not documented in 53% of cases, presumably for stress ulcer prophylaxis. Other indication were continuation of home medication without documented indication in 14%, stress ulcer prophylaxis in 12% and gastroesophageal reflux disease in 19% of the cases. Of the 37 patients initiated on proton pump inhibitors for stress ulcer prophylaxis, 54% were not candidate for stress ulcer prophylaxis.

Conclusion: The study showed overprescribing of proton pump inhibitors in our PICU, with poor documentation of indication. It is crucial to establish guideline and monitor their effect on the change in prescribing practices to insure safe and judicious use.

 Keywords: Proton Pump Inhibitors (PPIs); H⁺/K⁺ ATPase Enzyme; Gastroesophageal Reflux Disease (GERD); Stress Ulcer Prophylaxis (SUP); Paediatric Intensive Care Unit (PICU)

1. Schumock GT., et al. “National trends in prescription drug expenditures and projections for 2016”. American Journal of Health-System Pharmacy 14 (2016): 1058-1075.
2. Lanas A. “We are using too many PPIs, and we need to stop: a European perspective”. Official Journal of the American College of Gastroenterology| ACG 8 (2016): 1085-1086.
3. Edinoff AN., et al. “Proton Pump Inhibitors, Kidney Damage, and Mortality: An Updated Narrative Review”. Advances in Therapy6 (2023): 2693-2709.
4. Duffett M., et al. “Pediatric intensive care stress ulcer prevention (PIC-UP): a protocol for a pilot randomized trial”. Pilot and Feasibility Studies 3 (2017): 26.
5. Dhaliwal MS., et al. “Gastrointestinal issues in PICU: An unopened chapter”. Journal of Pediatric Critical Care4 (2016): 85-100.
6. Patil R and Blankenship L. “Proton pump inhibitors and Clostridium difficile infection: are we propagating an already rapidly growing healthcare problem?”. Gastroenterology Research5 (2013): 171-173.
7. Costarino AT., et al. “Gastric acid suppressant prophylaxis in pediatric intensive care: current practice as reflected in a large administrative database”. Pediatric Critical Care Medicine7 (2015): 605-612.
8. Wang Y., et al. “Efficacy and safety of gastrointestinal bleeding prophylaxis in critically ill patients: systematic review and network meta-analysis”. BMJ 368 (2020): I6744.
9. Deerojanawong J., et al. “Incidence and risk factors of upper gastrointestinal bleeding in mechanically ventilated children”. Pediatric Critical Care Medicine1 (2009): 91-95.
10. Keivanfar M., et al. “Evaluation of Proper Prescription of Antacid Agents in a Group of Critically Ill Children Admitted to PICU in 2018-2019”. International Journal of Pediatrics 10 (2022): 16656-16665.
11. Joret-Descout P., et al. “Guidelines for proton pump inhibitor prescriptions in paediatric intensive care unit”. International Journal of Clinical Pharmacy1 (2017): 181-186.
12. Vazin A., et al. “Evaluation of stress ulcer prophylaxis guideline in the intensive care units of a teaching hospital: a cross sectional study”. Journal of Pharmaceutical Care 8 (2020): 65-69.
13. Blackett JW., et al. “Prevalence and risk factors for inappropriate continuation of proton pump inhibitors after discharge from the intensive care unit”. Mayo Clinic Proceedings10 (2021): 2550-2560.
14. Tawam D., et al. “The positive association between proton pump inhibitors and Clostridium difficile infection”. Innovations in Pharmacy1 (2021): 1-7.
15. El-Ella SS., et al. “Stress ulcer prophylaxis for critically ill children: Routine use needs to be re-examined”. Anales de Pediatría (English Edition) 96 (2022): 402-409.