Abstract
PREDICTORS OF INAPPROPRIATE USE OF PROTON PUMP INHIBITORS IN CHILDREN AT MAKASSED GENERAL HOSPITAL IN LEBANON

May Al Dika, Ziad Naja, Mariam Rajab and Amal Naous*

ABSTRACT

Introduction: There are growing concerns that the use of proton pump inhibitors (PPIs) may be inappropriate in instances that do not conform to evidence-based indications. This study aimed to investigate the frequency, indications, appropriateness and predictors of PPIs use in hospitalized pediatric patients. Methods: All inpatients aged between 0 and 17 years and given any form of proton pump inhibitors during their hospitalization in the pediatric floor or the intensive care units in Makassed General Hospital between January 1, 2009 and December 31, 2014 were documented. Indications for maintaining these patients on PPIs were obtained from the medical records, which were then recorded and cross-referenced against a list of accepted indications adapted from the US Food and Drug Administration (FDA)-approved list. Results: Of the 621 inpatients using PPIs, only 10 (1.6 %) fulfilled the FDA-approved indications, while the majority (n =464, 74.7 %) did not, 147 (23.5 %) had borderline indications based on guidelines other than that of FDA. Logistic regression showed that the highly statistically significant variables were the following: poor weight gain, Clo test, PH metry, and hospitalization. Poor weight gain and those who did PH metry during hospitalization were among the predictors of appropriate PPI use. With respect to poor weight gain, the odds ratio = 0.239, 95 % CI: 0.143 -0.399, and P value< 0.0001. As for PH metry, odds ratio: 0.046, 95 % CI: [0.016-0.135], P value < 0.0001. While inappropriate use of PPIs was 10 times higher in patients who were admitted to pediatrics floor, and 2 times higher in patients who did Clo test (odds ratio were shown to be 10.721 and 2.126 respectively, and P values < 0.0001 and 0.007 respectively). Conclusion: Although the use of PPIs is prevalent in hospitals, less than half of the hospitalized patients using PPIs in our study had evidence-based indications that supported such use.

Keywords: Proton Pump Inhibitors; Pediatric patients; indications.


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