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Stress ulcer prophylaxis use in critical care units at public hospitals in Johannesburg, South Africa

BACKGROUND: Stress ulcer prophylaxis (SUP) is part of the management of critically ill patients in intensive care units (ICUs). However, inappropriate use of these drugs has important clinical implications such as ventilator-associated pneumonia and Clostridium difficile-associated gastrointestinal...

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Autores principales: Biyase, N, Perrie, H, Scribante, J, Muteba, M, Chetty, S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: South African Medical Association 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9045497/
https://www.ncbi.nlm.nih.gov/pubmed/35498762
http://dx.doi.org/10.7196/SAJCC.2021.v37i1.439
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author Biyase, N
Perrie, H
Scribante, J
Muteba, M
Chetty, S
author_facet Biyase, N
Perrie, H
Scribante, J
Muteba, M
Chetty, S
author_sort Biyase, N
collection PubMed
description BACKGROUND: Stress ulcer prophylaxis (SUP) is part of the management of critically ill patients in intensive care units (ICUs). However, inappropriate use of these drugs has important clinical implications such as ventilator-associated pneumonia and Clostridium difficile-associated gastrointestinal tract infections. The overuse of proton pump inhibitors (PPIs) as SUP is a rapidly growing problem globally. OBJECTIVES: To describe the use of SUP in three selected ICUs in Johannesburg, South Africa (SA). METHODS: A retrospective, descriptive, contextual study design was used. Data were collected from ICU records of adult patients admitted into these units during the study period (1 August 2013 - 31 October 2013). RESULTS: A total of 174 patients were included in the study. Of these, 156 were on SUP and only 38.5% (n=60/156) were appropriately treated with SUP according to the American Society of Health-System Pharmacists guidelines. There was an inappropriate use of SUP in over 50% of those who were treated. The most frequently prescribed SUP was histamine-2 receptor antagonist (H2RA) (51.3%; n=80/156), followed by PPIs (30.8%; n=48/156), sucralfate (17.3%; n=27/156), and a combination of PPI and H2RA (0.6%; n=1/156). CONCLUSION: The study demonstrated overuse of SUP. The most commonly used drug for SUP was H2RA and not PPIs. This study demonstrates that the problem of SUP overuse internationally also exists locally. The development of local guidelines may help to improve the practice of SUP in SA. CONTRIBUTIONS OF THE STUDY: This study showed overuse of SUP and should encourage doctors to critically evaluate why they prescribe SUP and whether it is really indicated. This should help in the adoption of practices towards appropriate use of SUP.
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spelling pubmed-90454972022-04-28 Stress ulcer prophylaxis use in critical care units at public hospitals in Johannesburg, South Africa Biyase, N Perrie, H Scribante, J Muteba, M Chetty, S South Afr J Crit Care Research BACKGROUND: Stress ulcer prophylaxis (SUP) is part of the management of critically ill patients in intensive care units (ICUs). However, inappropriate use of these drugs has important clinical implications such as ventilator-associated pneumonia and Clostridium difficile-associated gastrointestinal tract infections. The overuse of proton pump inhibitors (PPIs) as SUP is a rapidly growing problem globally. OBJECTIVES: To describe the use of SUP in three selected ICUs in Johannesburg, South Africa (SA). METHODS: A retrospective, descriptive, contextual study design was used. Data were collected from ICU records of adult patients admitted into these units during the study period (1 August 2013 - 31 October 2013). RESULTS: A total of 174 patients were included in the study. Of these, 156 were on SUP and only 38.5% (n=60/156) were appropriately treated with SUP according to the American Society of Health-System Pharmacists guidelines. There was an inappropriate use of SUP in over 50% of those who were treated. The most frequently prescribed SUP was histamine-2 receptor antagonist (H2RA) (51.3%; n=80/156), followed by PPIs (30.8%; n=48/156), sucralfate (17.3%; n=27/156), and a combination of PPI and H2RA (0.6%; n=1/156). CONCLUSION: The study demonstrated overuse of SUP. The most commonly used drug for SUP was H2RA and not PPIs. This study demonstrates that the problem of SUP overuse internationally also exists locally. The development of local guidelines may help to improve the practice of SUP in SA. CONTRIBUTIONS OF THE STUDY: This study showed overuse of SUP and should encourage doctors to critically evaluate why they prescribe SUP and whether it is really indicated. This should help in the adoption of practices towards appropriate use of SUP. South African Medical Association 2021-03-17 /pmc/articles/PMC9045497/ /pubmed/35498762 http://dx.doi.org/10.7196/SAJCC.2021.v37i1.439 Text en https://creativecommons.org/licenses/by-nc/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution - NonCommercial Works License (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Biyase, N
Perrie, H
Scribante, J
Muteba, M
Chetty, S
Stress ulcer prophylaxis use in critical care units at public hospitals in Johannesburg, South Africa
title Stress ulcer prophylaxis use in critical care units at public hospitals in Johannesburg, South Africa
title_full Stress ulcer prophylaxis use in critical care units at public hospitals in Johannesburg, South Africa
title_fullStr Stress ulcer prophylaxis use in critical care units at public hospitals in Johannesburg, South Africa
title_full_unstemmed Stress ulcer prophylaxis use in critical care units at public hospitals in Johannesburg, South Africa
title_short Stress ulcer prophylaxis use in critical care units at public hospitals in Johannesburg, South Africa
title_sort stress ulcer prophylaxis use in critical care units at public hospitals in johannesburg, south africa
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9045497/
https://www.ncbi.nlm.nih.gov/pubmed/35498762
http://dx.doi.org/10.7196/SAJCC.2021.v37i1.439
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