Concordance between use of proton pump inhibitors and prescribing guidelines

Med J Aust. 2000 Jan 3;172(1):16-8. doi: 10.5694/j.1326-5377.2000.tb123871.x.


Objective: To determine (i) the relationship between prescriptions for proton pump inhibitors (PPIs) and upper gastrointestinal conditions, and (ii) compliance 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 five consecutive weeks (11 January to 15 February 1999).

Main outcome measures: Recorded gastrointestinal conditions; previous trial of H2-antagonist therapy; compliance with PBS criteria for prescribing PPIs.

Results: Seventy patients (27.7%) had no appropriate upper gastrointestinal tract investigations, and 62 patients (24%) did not receive an adequate trial of H2-antagonist therapy before the commencement of a PPI. The major indications 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 patients (22.5%) did PPI prescriptions comply with PBS prescribing guidelines. Clinical indications that failed to meet prescribing criteria included milder forms of gastro-oesophageal reflux, gastritis/duodenitis, and non-specific dyspepsia with normal endoscopy results.

Conclusion: Drug utilisation data indicate widespread use of PPIs outside current prescribing guidelines. Many patients have not had relevant investigations and/or an adequate trial of H2-antagonist therapy. These findings explain the considerable hospital expenditure on PPIs.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Drug Utilization Review / standards*
  • Enzyme Inhibitors / economics
  • Enzyme Inhibitors / therapeutic use*
  • Female
  • Gastroesophageal Reflux / drug therapy
  • Guideline Adherence / statistics & numerical data*
  • Hospital Bed Capacity, 500 and over
  • Hospitals, Teaching
  • Hospitals, Urban
  • Humans
  • Male
  • Medical Records
  • Middle Aged
  • Omeprazole / economics
  • Omeprazole / therapeutic use*
  • Peptic Ulcer / drug therapy
  • Practice Patterns, Physicians' / statistics & numerical data
  • Proton Pump Inhibitors*
  • Queensland
  • Retrospective Studies


  • Enzyme Inhibitors
  • Proton Pump Inhibitors
  • Omeprazole