Document Type : Original Article
Authors
1
Clinical Pharmacy department, Faculty of pharmaceutical sciences and drug manufacturing, Misr University for science and technology, Giza, Egypt.
2
Clinical Pharmacy Department, Faculty of Pharmacy, October 6 University, Giza, Egypt.
3
Clinical Pharmacy, School of Life and Medical Sciences, University of Hertfordshire Hosted by Global Academic Foundation, New Administrative Capital, Egypt.
4
Critical Care Medicine, Faculty of Medicine, Cairo University, Giza, Egypt.
5
IQVIA, Cairo, Egypt.
6
Clinical Pharmacy Department, Faculty of Pharmacy, Menoufia University, Egypt.
7
Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Port said University, Port said, Egypt.
10.21608/rpbs.2025.409334.1391
Abstract
Background Stress ulcer prophylaxis (SUP) with proton pump inhibitors (PPIs) is widely used in intensive care units (ICUs) to prevent gastrointestinal bleeding in critically ill patients. This study evaluates PPI prescribing patterns in ICU patients, their appropriateness based on clinical risk factors, and associated outcomes, including therapeutic failure and adverse events.
Methods This retrospective cross-sectional study analyzed data from 158 adult ICU patients at El Moalmeen Private Hospital in Cairo, Egypt. Researchers collected demographic, clinical, and laboratory data using a structured form. The study evaluated PPI prescribing practices based on recognized major and minor risk factors for stress-related mucosal bleeding, along with instances of therapeutic failure and adverse effects.
Results In a study of 158 ICU patients (mean age 63.8 years, 57% male), hypertension (60.1%) and diabetes (41.8%) were prevalent comorbidities, with pneumonia (41.1%) as the leading cause of admission, followed by acute kidney injury and altered consciousness (10.1% each). Only 44.9% of PPI prescriptions were appropriate, with 22.2% supported by major indications and 24.1% by two or more minor indications. However, 55.1% of PPI use lacked clear justification. Therapeutic failure occurred in 12.7% of cases, and Clostridioides difficile infection was noted in 5.1%. Logistic regression identified older age (OR 1.04) and chronic kidney disease (OR 4.98) as significant predictors of PPI overprescription.
Conclusion Inappropriate PPI use for SUP remains prevalent in ICU patients. Advanced age and chronic kidney disease are key predictors, highlighting the need for evidence-based guidelines and increased prescriber awareness to optimize therapy and reduce adverse outcomes.
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