Analysis Of The Utilization Of Drugs For Peptic Ulcer Disease And Assess The Rationality Of The Use Of Proton Pump Inhibitors In Our Hospital

Objective:To investigate the current situation and developing trend of antiulcer drugs in our hospital for successive 3 years; to evaluate the intravenous proton pump inhibitions prescribing in our hospital, and analyze the influential factors of inappropriate utilization, in order to offer the scientific evidence for appropriate use of proton pump inhibitions.Methods:1. Antiulcer drugs used in our hospital from 2008 to 2010 were analyzed statistically in respect of sales value, DDDs and DDC.2. Take our hospital in 2010 in-patient as object of study, choose completive integrated cases used intravenous proton pump inhibitions at least once, by pure random sampling, retrospective review the cases to assess appropriateness of intravenous proton pump inhibitor prescribing.3. SPSS(version 16.0)was used for statistical analyses.Univariate analysis was used to examine the associations between individual predictors and the appropriate use of intravenous proton pump inhibitions. Multivariate analysis adopts the backward methods (with odds ratio and 95% confidence intervals) was performed using logistical regression analysis.Results:1. The consumption sum of antiulcer drug showed an upward trend from 2008 to 2010, the annual incremental rate were 31.59% and 42.59%, respectively. Consumption costs proportion of histamine-2 receptor blockers decreased year by year, proton pump inhibitors had a absolutely superiority in clinic, with kinds and consumption costs increased year by year, and continually ranked first for 3 years, the annual incremental rate were 31.74% and 44.11%, respectively.2. DDDs of the drugs ranking in the first 5 places of 2008 were pantoprazole injections, omeprazole injections, ranitidine injections, pantoprazole oblatums and esomeprazole tabletst, DDDs of the drugs ranking in the first 5 places of 2009 and 2010 were pantoprazole injections, omeprazole injections, pantoprazole oblatums, esomeprazole tabletst and ranitidine oblatums.3.1920 cases were investigated for evaluate the appropriate use of the intravenous proton pump inhibitions. Among 53.5%(1028/1920) males and 46.5%(892/1920) females, in which the youngest is 1 years old, the oldest is 93 years old, the average is 47.13 years old.4. In all cases,9.9%(190/1920) had appropriately used intravenous proton pump inhibitions,90.1%(1730/1920) inappropriate.5. Improper indication is the main reason of inappropriate use of intravenous proton pump inhibitions, account for 76.3%(1465/1920).The main reason of the utilization is for prophylaxis,91.4%(1755/1920). 50.3%(967/1920) for stress ulcer prophylaxis,71.7%(1376/1920) of prophylactic use with improper indication. There was a certain degree of irrational use on usage,75.0%(171/228) of intravenous omeprazole (luosaike) were not according to the directions to use the special dissolvent for intravenous injection.6. Multi-variate unconditional Logistic regression indicates the risk factors of improper indication, admission condition were negative correlate with improper indication, if co-medication of NSAIDs, if co-medication anticoagulation, if endoscopy were positive correlate with improper indication, which means the common admission condition related with higher rate of inappropriate use, co-medication anticoagulation, co-medication anticoagulation, endoscopy related with lower rate of inappropriate use.Conclusion:1. Intravenous PPIs were widespread used in clinic, DDDs outclass the peroral proton pump inhibitions and other antiulcer drugs, that might relate with the overuse of PPIs.2. The majority use of Intravenous PPIs were for prophylaxis, prophylaxis with unreasonable indications were common.3. The common admission condition related with higher rate of inappropriate use, co-medication anticoagulation, co-medication anticoagulation, endoscopy related with lower rate of inappropriate use.4. It is suggested to establish guidelines on rational use of PPIs, change the attitude and prescribing behaviors of physicians, enhance interventional measures, in order to change the situation of inappropriate utilization.