Objective: To determine (i) the relationship between prescriptions for prot
on pump inhibitors (PPIs) and upper gastrointestinal conditions, and (ii) c
ompliance with Pharmaceutical Benefits Scheme (PBS) prescribing guidelines
for PPIs.
Design: Drug utilisation evaluation.
Setting: 800-bed metropolitan teaching hospital.
Participants: 253 patients dispensed PPIs from the hospital pharmacy over f
ive consecutive weeks (11 January to 15 February 1999).
Main outcome measures: Recorded gastrointestinal conditions; previous trial
of H-2- antagonist therapy; compliance with PBS criteria for prescribing P
PIs.
Results: Seventy patients (27.7%) had no appropriate upper gastrointestinal
tract investigations, and 62 patients (24%) did not receive an adequate tr
ial of H-2-antagonist therapy before the commencement of a PPI. The major i
ndications for use of PPIs in investigated patients were gastro-oesophageal
reflux in 99 (54%) and peptic ulcer disease in 30 (16.4%). In only 57 pati
ents (22.5%) did PPI prescriptions comply with PBS prescribing guidelines.
Clinical indications that failed to meet prescribing criteria included mild
er forms of gastro-oesophageal reflux, gastritis/duodenitis, and non-specif
ic dyspepsia with normal endoscopy results.
Conclusion: Drug utilisation data indicate widespread use of PPIs outside c
urrent prescribing guidelines. Many patients have not had relevant investig
ations and/or an adequate trial of H-2-antagonist therapy. These findings e
xplain the considerable hospital expenditure on PPIs.