Use of intravenous proton pump inhibitors in community practice: An explanation for the shortage?

BACKGROUND: Since 2001, one intravenous proton pump inhibitor (pantoprazole) has been available in the United States. A drug shortage bulletin was issued for this agent in 2003. AIM: To evaluate the patterns of use of intravenous proton pump inhibitors (IV PPIs) in routine clinical practice. METHODS: Prospective evaluation of IV PPI use in two community-based teaching hospitals. A computerized pharmacy ordering system was used to identify all patients for whom an IV PPI was ordered. Trained investigators obtained clinical data from patient records and these data were mapped to establish clinical criteria for the use of IV PPIs. RESULTS: Intravenous PPIs were prescribed in 238 patients over a 30-day period and a total of 1,631 doses were prescribed. Primary care providers prescribed 46% of prescriptions. Fifty-six percent of patients who received IV PPIs had no acceptable indication for their use. Of the 126 (81%) patients who were started on PPIs for the first time during their hospital stay, 102 were discharged on a PPI. CONCLUSIONS: Intravenous PPIs are widely used for poor indications, which may contribute to the shortage of these agents.