A significant number of prescriptions for gastric acid suppressants are written without an appropriate indication, according to a cross-sectional study published in Plos One.
To identify trends in gastric acid suppressant use, researchers from the University of Texas at Austin analyzed data from the National Ambulatory Medical Care Survey from 2009 to 2015. They classified any outpatient visit with a documented prescription for a proton pump inhibitor (PPI) or histamine-2 receptor antagonist (H2RA) as a gastric acid suppressant use. “Use was calculated as the number of prescriptions per total outpatient visits per year,” the authors explained. “Appropriateness of prescribing was assessed using FDA-approved indications listed in each visit.”
The results included a total of 6.8 billion outpatient visits, of these, 8.8% (nearly 600 million) had documented gastric acid suppressant use. However, only 15.8% of users had a documented indication. The most commonly prescribed PPIs were omeprazole (52.1%), esomeprazole (18.9%), and pantoprazole (14.9%); ranitidine (63.0%) and famotidine (32.7%) were the most common H2RAs.
Compared with 2009-2011, gastric acid suppressant prescribing was found to be significantly higher from 2012-2015 (8.6% vs 9.1%; P<.0001). “These trends did not correspond to proportions of documented [gastric acid suppressant] indications, which decreased over time from 2.7% in 2009 to 2.2% in 2015,” the authors added.
With regard to PPI use, the prescribing rate increased by only 0.6% from 2009 to 2015; this may have been due to new safety data which linked PPIs to various side effects including bone fractures and Clostridium difficile infection. “The timing of these safety warnings could potentially explain the decrease in prescribing of PPIs seen from 2009 to 2012,” noted the authors. “However, this decreasing trend was only short-term as PPI prescribing once again increased from 2012 to 2015.”
In light of recent safety data regarding the long-term use of PPIs, the authors concluded that “judicious” prescribing is necessary, given that almost 85% of outpatient visits did not document an appropriate indication for gastric acid suppressant use.
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