The silent epidemic: Inappropriate use of proton pump inhibitors among hospitalized patients

Background and study aims: There is an increasing trend to inappropriately prescribe proton pump inhibitors (PPIs) in different clinical settings despite the reported adverse outcomes. This study aimed to assess (1) the prevalence of potentially inappropriate use of PPIs and its associated risk factors among hospitalized patients, at pre-admission and discharge and (2) the prevalence of valid indications of PPIs use without prescription. Patients and methods: A retrospective observational study was performed at a single center, examining the records of patients aged >= 18 years who were admitted to the Family Medicine inpatient service over a one-year period. The appropriateness of PPIs use was assessed against a set of pre-approved indications. Results: A total of 289 patients were included in the analysis. Of these, 34.67 % were taking PPIs upon admission, increasing to 43.67 % at discharge (p < 0.001). Inappropriate PPI use was identified in 51.92 % at pre-admission and 57.25 % at discharge. Multivariate analysis identified significant factors contributing to inappropriate PPI use: polypharmacy at both admission and discharge (OR = 4.587, p = 0.031), and the presence of two or more comorbidities at discharge (OR = 5.421, p = 0.011; OR = 13.005, p = 0.037). Age <= 65 was associated with increased inappropriate use only at discharge (p < 0.003). Conversely, appropriate prescribing was noted in patients over 65 and those on antiplatelet therapy, aligning with clinical guidelines. Conclusions: This study reveals a high prevalence of inappropriate PPI use among hospitalized patients, notably increasing from admission to discharge. Key contributors to inappropriate PPI usage included polypharmacy and high comorbidity scores at discharge, particularly in patients under 65. This emphasizes the need for targeted interventions to optimize PPI prescribing practices in clinical settings.