Stress ulcer is a superficial and asymptomatic lesion and causes bleeding. As many as 50% of death cases are reported as the result of stress ulcer bleeding. Stress ulcer prophylaxis (SUP) is a drug used to prevent gastrointestinal tract injuries due to stress ulcers. The inappropriate use of SUP drugs can cause adverse drug reactions, and thus SUP drugs are only given to patients in accordance with guidelines in order to avoid the overuse of SUP drugs. The aim of this present study is to analyse the suitability of SUP drug usage based on the criteria from the American Society of Health-System Pharmacists (ASHP) and the drug costs of SUP overuse.
An observational descriptive study was conducted from April 24, 2019, to May 17, 2019, in the inpatient surgical ward of Dr. Soetomo General Hospital. Data were obtained from patient medical health records.
One hundred fifty-two patients used 1404 SUP drugs. Approximately 48% of usage did not suit the ASHP criteria and was considered as medication overuse. The cost of excessive SUP usage during the study period was more than US $65, which is 30.08% of the total drug cost of prescribed stress ulcer drugs.
The present study suggests that the relatively high excessive drug costs for SUP show a need for monitoring of the application of SUP therapy guidelines.
Gratitude is due to the director and the head of the Inpatient Operating Room of Dr. Soetomo General Hospital.
Research funding: We thank to Tahir Foundation professorship program (Dr. Suharjono) for supporting the study.
Author contributions: All authors have accepted responsibility for the entire content of the manuscript and approved its submission.
Competing interests: The authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: This study was designed to comply the criteria for ethical conduct and was approved by the Health Research Ethics Committee of Dr. Soetomo General Hospital, with reference number 1121/KEPK/IV/2019.
 Shuman R, Schuster D, Zuckerman GR. Prophylactic therapy for stress ulcer bleeding: a reappraisal. Ann Intern Med 1987;106:562–7.10.7326/0003-4819-106-4-562Search in Google Scholar PubMed
 Buendgens L, Koch A, Tacke F. Prevention of stress-related ulcer bleeding at the intensive care unit: risks and benefits of stress ulcer prophylaxis. World J Crit Care Med 2016;5:57–64.10.5492/wjccm.v5.i1.57Search in Google Scholar PubMed PubMed Central
 Barletta JF, Bruno JJ, Buckley MS, Cook DJ. Concise. Definitive review: stress ulcer prophylaxis. Crit Care Med 2016; 4 (7): 1395– 1405.10.1097/CCM.0000000000001872Search in Google Scholar PubMed
 Guillamondegui OD, Gunter OL, Bonadies JA, Coates JE, Kurek SJ, De Moy MA, Sing RF, Alan J, Sori AJ. Practice management guidelines for stress ulcer prophylaxis. EAST Practice Management Guidelines Committee. Eastern Association for the Surgery of Trauma, 2008.Search in Google Scholar
 Zeitoun A, Zeineddine M, Dimassi H. Stress ulcer prophylaxis guidelines: are they being implemented in Lebanese health care centers? World J Gastrointest Pharmacol Ther 2011;2:27–35.10.4292/wjgpt.v2.i4.27Search in Google Scholar PubMed PubMed Central
 Schefold JC, Perner A, Lange T, Wetterslev J, Wise MP, Borthwick M, et al. Effects of stress ulcer prophylaxis in adult ICU patients receiving renal replacement therapy (Sup-Icu RENal, SIREN): study protocol for a pre-planned observational study. Trials 2018;19:26.10.1186/s13063-017-2408-3Search in Google Scholar PubMed PubMed Central
 Ye Z-K, Liu Y, Cui X-L, Liu L-H. Critical appraisal of the quality of clinical practice guidelines for stress ulcer prophylaxis. PLoS One 2016;11:e0155020.10.1371/journal.pone.0155020Search in Google Scholar PubMed PubMed Central
 Heidelbaugh J, Inadomi J, Goldberg K. Magnitude and economic impact of inappropriate use of stress ulcer prophylaxis in non-ICU hospitalized patients. Am J Gastroenterol 2006;101:2200–5.10.1111/j.1572-0241.2006.00839.xSearch in Google Scholar PubMed
 Heidelbaugh JJ, Goldberg KL, Inadomi JM. Magnitude and economic effect of overuse of antisecretory therapy in the ambulatory care setting. Am J Manag Care 2010;16:e228–34.Search in Google Scholar
 Perwaiz MK, Posner G, Hammoudeh F, Schmidt F, Neupane N, Enriquez D, et al. Inappropriate use of intravenous ppi for stress ulcer prophylaxis in an inner city community hospital. J Clin Med Res 2010;2:215–9.Search in Google Scholar
 Farrell CP, Mercogliano G, Kuntz CL. Overuse of stress ulcer prophylaxis in the critical care setting and beyond. J Crit Care 2010;25:214–20.10.1016/j.jcrc.2009.05.014Search in Google Scholar PubMed
 Singh A, Bodukam V, Saigal K, Bahl J, Wang Y, Hanlon A, Lu Yinghui, Davis Michael, et al. Indentifying risk factors associated with inappropriate use of acid suppressive theraphy at a community hospital. Gastroenterol Res Pract. 2016;2016:1–7. Article ID 1973086.10.1155/2016/1973086Search in Google Scholar PubMed PubMed Central
 Chen P, Reddy N, Loesch E, Agrawal S. Appropriateness of stress ulcer prophylaxis in hospitalized patients. J Gastric Disord Ther 2016;2.10.16966/2381-8689.122Search in Google Scholar
 Akshaya D, Sarala K, Sharmila R. A study of select determinants for hospital stay among surgical patients ina tertiary care hospital. Int J Manage Appl Sci 2016;2:37–43.Search in Google Scholar
 Almeman A, Alkhoshaiban A, Rasool S. Prescribing practices and cost of drugs for peptic ulcer in a primary health center in Pulau Penang Malaysia. Trop J Pharm Res 2013;12:629–34.10.4314/tjpr.v12i4.28Search in Google Scholar
 Kalinowski CP, Kirsch JR. Strategies for prophylaxis and treatment. Best Pract Res Clin Anaesthesiol 2004;18:719–37.10.1016/j.bpa.2004.05.008Search in Google Scholar PubMed
 Syrigou E, Triantafyllou O, Makrilia N, Kaklamanos I, Kotanidou A, Manolopoulos L, et al. Acute hypersensitivity reactions to chemotherapy agents: an overview. Inflamm Allergy Drug Targets, 2010;9:206–13.10.2174/187152810792231887Search in Google Scholar PubMed
 Sheikh-Taha M, Alaeddine S, Nassif J. Use of acid suppressive therapy in hospitalized non–critically ill patients. World J Gastrointest Pharmacol Ther 2012;3:93–6.10.4292/wjgpt.v3.i6.93Search in Google Scholar PubMed PubMed Central
 Bez C, Perrottet N, Zingg T, Leung Ki EL, Demartines N, Pannatier A. Stress ulcer prophylaxis in non-critically ill patients: a prospective evaluation of current practice in a general surgery department. J Eval Clin Pract 2012;19:374–8.10.1111/j.1365-2753.2012.01838.xSearch in Google Scholar PubMed
 Goldstein J, Cryer B. Gastrointestinal injury associated with NSAID use: a case study and review of risk factors and prevention strategies. Drug Health Patient Saf 2015;7:31–41.10.2147/DHPS.S71976Search in Google Scholar PubMed PubMed Central
 Batlouni M. Nonsteroidal anti-inflammatory drugs: cardiovascular, cerebrovascular and renal effects. Arq Bras Cardiol 2010;94:556–63.10.1590/S0066-782X2010000400019Search in Google Scholar PubMed
 Pisegna JR. Pharmacology of acid suppression in the hospital setting: focus on proton pump inhibition. Crit Care Med 2002;30:S356–61.10.1097/00003246-200206001-00003Search in Google Scholar PubMed PubMed Central
 Abdi AM, Shah SS, Albaghdadi H, Basgut B. Rational drug use in stress ulcer prophylaxis at a tertiary hospital in Northern Cyprus. Int J Pharm Technol 2017;9:31047–58.Search in Google Scholar
 Cook D, Guyatt G. Prophylaxis against upper gastrointestinal bleeding in hospitalized patients. N Engl J Med 2018;378:2506–16.10.1056/NEJMra1605507Search in Google Scholar PubMed
 Anderson ME. Stress ulcer prophylaxis in hospitalized patients. Hos Med Clin. 2013;2:e32–e44.10.1016/j.ehmc.2012.07.004Search in Google Scholar
 Deshpande S, Dessoky M, Brock P. Algorithm based management improves compliance with stress ulcer prophylaxis in ICU. J Anaesth Pract 2017.Search in Google Scholar
 Roselló S, Blasco I, García Fabregat L, Cervantes A, Jordan K, ESMO Guidelines Committee. Management of infusion reactions to systemic anticancer therapy: ESMO clinical practice guidelines. Ann Oncol 2017;28:iv100–18.10.1093/annonc/mdx216Search in Google Scholar PubMed
 Mohamad S, Shamsudin N, Tan KM. Appropriateness of stress ulcer prophylaxis among older adults admitted to general medical wards in a university hospital. Eur Geriatr Med 2015;6:119–23.10.1016/j.eurger.2014.11.004Search in Google Scholar
 Verma P, Thakur AS, Deshmukh K, Jha AK, Verma S. Routes of drug administration. Int J Pharm Stud Res 2010;1:54–9.Search in Google Scholar
 Cyriac JM, Emmanuel J. Switch over from intravenous to oral therapy: a concise overview. J Pharmacol Pharmacother 2014;5:83–7.10.4103/0976-500X.130042Search in Google Scholar PubMed PubMed Central
 Shin S. Evaluation of costs accrued through inadvertent continuation of hospital-initiated proton pump inhibitor therapy for stress ulcer prophylaxis beyond hospital discharge: a retrospective chart review. Ther Clin Risk Manage 2015;11:649–57.10.2147/TCRM.S81759Search in Google Scholar PubMed PubMed Central
© 2019 Walter de Gruyter GmbH, Berlin/Boston