Background The kind of patients we can find in a geriatric centre have various comorbidities, which implies that they usually have more than one medicine. It is common to have drug interactions.
Purpose To evaluate the rational use of proton pump inhibitors (PPIs) in a geriatric centre with 300 beds attached to a second-level hospital.
Material and methods We performed a cross descriptive study in all patients of a geriatric centre with PPI treatment in July 2014. Medical histories were reviewed and a database was designed: PPI, drug dose, diagnosis and concomitant NSAID treatment.
PPI criteria for use were based on the current evidence available. Esomeprazole was limited to patients with a nasogastric tube, as it´s the only one that can be administered in this way.
Results PPIs were prescribed in 80% of patients.
Omeprazole was prescribed in 197 patients: 39% (77/197) had a gastrointestinal diagnosis and 61% (120/197) had no indication recorded, of which 57.5% (69/120) were on chronic NSAID treatment. Drug dosages were: 52.3% (103/197) 20 mg/24 h, 20 mg/12 h in 46.7% (92/197) and 0.5% (1/197) with 20 mg/8 h or 40 mg/8 h.
The 42.5% (51/120) of patients whose treatment indication was unknown were re-evaluated: In 19.6% (10/51) the drug was suspended, in 58.8% (30/51) doses were changed to 20 mg/24 h. The remaining 21.6 (11%) patients were not changed without a clear medical reason.
Esomeprazole was prescribed in 45 patients: 24% (11/45) had digestive diseases and 76% (34/45) had no indication recorded, of whom 61.7% (21/34) were on chronic NSAID treatment. Drug doses were: 66.7% (30/45) 20 mg/24 h and 40 mg/24 h in 33.3% (15/45).
The 38.2% (13/34) patients whose treatment indication was unknown were re-evaluated: in 69.2% (9/13) the drug was suspended, 30.8% (4/13) were switched to omeprazole 20 mg/24 h.
Only 28.9% (13/45) were carriers of a nasogastric tube.
Conclusion Inappropriate use of PPIs was observed in terms of indication and drug dose.
Prophylaxis of gastropathy in patients on NSAIDs was the most common correct indication.
It is important to incorporate clinical pharmacists in geriatric centre teams to ensure and promote the rational use of medicines.
ReferenceNo conflict of interest.
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