Do you want to buy antibiotics online without prescription? https://buyantibiotics-24h.com/ - This is pharmacy online for you!
Stress ulcer prophylaxis
GUIDELINES FOR APPROPRIATE STRESS ULCER PROPHYLAXIS
The following information, derived from the ASHP guidelines, can be used as a screening
tool to determine appropriateness of prophylaxis.
Medical Intensive Care Unit patients
ONE OR MORE OF THE FOLLOWING RISK FACTORS
• Likely to require mechanical ventilation for > 48 hours
• Non-intentional coagulapathy, i.e. not on warfarin, heparin, or other anticoagulants resulting
in an INR > 1.5, platelets < 50,000 or therapeutic aPTT
Medical Intensive Care Unit patients
TWO OR MORE OF THE FOLLOWING RISK FACTORS
• History of gastric ulceration or bleeding within the last 12 months PTA
• Head injury with Glascow Coma Score (GCS) < 10
• Multiple trauma with an injury severity score > 16
• Hepatic failure or renal failure (serum creatinine > 5.7 mg/dL)
Stress Ulcer Prophylaxis
Stress ulcers are superficial inflammatory lesions of the gastric mucosa caused by abnormally
elevated physiological demands on the body. Studies have reported evidence of mucosal damage within 24 hours of admittance in 75-100% of intensive care unit (ICU) patients. This damage can be associated with a significant bleeding risk and therefore, certain patients require prophylaxis. The most current guidelines for stress ulcer prophylaxis (SUP), written by the American Society of Health-System Pharmacists (ASHP) in 1999, include recommendations for ICU patients only. Prophylaxis is not recommended for medical or surgical patients who are not in the ICU. However, data has shown that inappropriate use of acid-suppressive therapy (AST) in general medicine units has been as high as 71%. The use of AST has been linked to an increased risk of serious infections such as pneumonia and Clostridium difficile
associated disease along with elevated risk of fractures. Inappropriate use also increases drug costs for hospitals and patients. For these reasons, it is important to determine the patient populations in which stress ulcer prophylaxis is appropriate.
To prevent 1 case of clinically important GI bleeding, you need to treat 60 ICU pts
To prevent one case of overt GI bleeding, you need to treat 18 ICU pts
One add’l case of nosocomial pneumonia will occur for every 25 ICU pts
treated with H2RA1
Outpatient treatment with PPI has a 2.9-fold higher incidence
of community-acquired C. difficile
H2RAs have a 2-fold higher incidence2 risk associated with inpatient C. difficile.
Corticosteroid use alone is not a risk factor for stress ulcers1,2,3
Coagulopathies must be intrinsic-not resulting from treatment with warfarin or heparin, etc.3
Most data uses H2RA, antacids, or sucralfate in studies, very little data on use of PPIs
Most patients will not
meet criteria for stress ulcer prophylaxis
Trials only in ICU patients; there is NO DATA IN MEDICAL PATIENTS
Stress ulcer prophylaxis in hospitalized patients not in intensive care unitsul 1;64(13):1396-400.
Proton pump inhibitors: appropriate use and safety concerns. Pharmacist's Letter/Prescriber's Letter
. Descriptive analysis of a clinical pharmacy intervention to improve the appropriate use of stress ulcer prophylaxis in a hospital infectious disease warar;16(2):114-21.
Stevens AM, Thomas Z. The case against stress ulcer prophylaxis in 2007. Hospital Pharmac; 42(11):995–1002.
Heidelbaugh JJ, Inadomi JM. Magnitude and Economic Impact of Inappropriate Use of Stress Ulcer Prophylaxis in Non-ICU Hospitalized Patients. American Journal of Gastroenterology 2006; doi: 10.1111/j.1572-0241.2006.00839.x
Cook DJ, Fuller HD, Guyatt GH, et al. Risk Factors for Gastrointestinal Bleeding in Critically Ill Patients; NEJM 1994; 330(6) :377-81.
Farrell CP, Mercogliano G, Kuntz CL. Overuse of stress ulcer prophylaxis in the critical care setting and beyond. J Crit Care 2009;
Hussain S, Stefan M, Visintainer P, Rothberg M. Why Do Physicians Prescribe Stress Ulcer Prophylaxis to General Medicine Patients? Southern Medical Journal 2010; 103 (11): 1103-10.
Qadeer MA, Richter JE, Brotman DJ. Hospital-Acquired Gastrointestinal Bleeding Outside the Critical Care Unit. Risk Factors, Role of Acid Suppression, and Endoscopy Findings. J Hosp Med 2006; 1 (1):13-20.
Sesler JM. Stress-related Mucosal Disease in the Intensive Care Unit. An Update on Prophylaxis.
AACN Advanced Critical Care 2007; 18 (2): 119–128.
Singh H, Houy TL, Singh N, Sekhon S. Gastrointestinal Prophylaxis in Critically Ill Patients.
Crit Care Nurs Q 2008;
31 (4): 291–301.
Anon. ASHP Therapeutic Guidelines on Stress Ulcer Prophylaxis. Am J Health-Syst Pharm. 1999; 56:347-79
Quenot JP, Thiery N, BarbarS. When should stress ulcer prophylaxis be used in the ICU? Current Opinion in Critical Care 2009,15:139–143.
Allen ME, Kopp BJ, Erstad BL. Stress ulcer prophylaxis in the postoperative period. Am J Health-Syst Pharm. 2004; 61:588-96
Proton Pump Inhibitors (PPIs) - Drug Safety Communication: Clostridum Difficile-Associated Diarrhea (CDAD) Can be Associated With Stomach Acid Drugs
U.S. National Library of Medicine. National Institutes of Health. Health topics-Clostridium difficile
infections(Accessed January 31, 2012).
Al-Tureihi FI, Hassoun A, Wolf-Klein G, Isenberg H. Albumin, length of stay, and proton pump inhibitors: key factors in Clostridium difficile
-associated disease in nursing home patients
Cunningham R, Dale B, Undy B, Gaunt N. Proton pump inhibitors as a risk factor for Clostridium difficile
Dial S, Alrasadi K, Manoukian C, et al. Risk of Clostridium difficile
diarrhea among hospital in-patients prescribed proton pump inhibitors:cohort and case-control studies
Dial S, Delaney JA, Barkun A, Suissa S. Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile
Muto C, Pokrywka M, Shutt K, et al. A large outbreak of Clostridium difficile-
associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone us
Pepin J, Saheb N, Coulombe MA, et al. Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile
-associated diarrhea: a cohort study during an epidemic in Quebec
Shah S, Lewis A, Leopold D, et al. Gastric acid suppression does not promote clostridial diarrhoea in the elderly
Dial S, Delaney JA, Schneider V, Suissa S. Proton pump inhibitor use and risk of community-acquired Clostridium difficile
-associated disease defined by prescription for oral vancomycin therapy
Dial S, Kezouh A, Dascal A, et al. Patterns of antibiotic use and risk of hospital admission because of Clostridium difficile
Loo VG, Poirier L, Miller MA, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile
-associated diarrhea with high morbidity and mortality
Akhtar AJ, Shaheen M. Increasing incidence of Clostridium difficile
-associated diarrhea in African-American and Hispanic patients: association with the use of proton pump inhibitor therapy
Aseeri M, Schroeder T, Kramer J, Zackula R. Gastric acid suppression by proton pump inhibitors as a risk factor for Clostridium difficile
-associated diarrhea in hospitalized patients
Beaulieu M, Williamson D, Pichette G, Lachaine J. Risk of Clostridium difficile
associated disease among patients receiving proton-pump inhibitors in a Quebec medical intensive care uni
Cadle R, Mansouri M, Logan N, et al. Association of proton-pump inhibitors with outcomes in Clostridium difficile
Dalton B, Lye-Maccannell T, Henderson E, et al. Proton pump inhibitors increase significantly the risk of Clostridium difficile
infection in a low-endemicity, non-outbreak hospital setti
Dubberke ER, Reske KA, Yan Y, et al. Clostridium difficile
-associated disease in a setting of endemicity: identification of novel risk factors
Howell MD, Novack V, Grgurich P, et al. Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile
Janarthanan S, Ditah I, Kutait A, et al. A meta-analysis of 16 observational studies on proton pump inhibitor use and risk of Clostridium difficile
associated diarrhea [abstract]. American College of Gastroenterology Conference 2010; Abstract 378.
Jayatilaka S, Shakov R, Eddi R, et al. Clostridium difficile
infection in an urban medical center: five-year analysis of infection rates among adult admissions and association with the use of proton pump inhibitors
Kazakova SV, Ware K, Baughman B, et al. A hospital outbreak of diarrhea due to an emerging epidemic strain of Clostridium difficile
Kim JW, Lee KL, Jeong JB, et al. Proton pump inhibitors as a risk factor for recurrence of Clostridium-difficile
Leonard J, Marshall JK, Moayyedi P. Systematic review of the risk of enteric infection in patients taking acid suppressi
Linsky A, Gupta K, Lawler EV, et al. Proton pump inhibitors and risk for recurrent Clostridium difficile
Lowe DO, Mamdani MM, Kopp A, et al. Proton pump inhibitors and hospitalization for Clostridium difficile
-associated disease: a population-based study
Turco R, Martinelli M, Miele E, et al. Proton pump inhibitors as a risk factor for paediatric Clostridium difficile
Yearsley K, Gilby L, Ramadas A, et al. Proton pump inhibitor therapy is a risk factor for Clostridium difficile
What You Should Know Before You Start A Weight Loss Plan The measurements that count Know your Body Mass Index (BMI) Over the past twenty years, Americans have become more familiar with specific measurements related to health, such as cholesterol levels and blood pressure readings. When it comes to weight-related health risks, there are three important numbers that you should know. The
Communiqué de presse 12 septembre 2011 Merck Serono s’associe à la Fondation pour Genève pour honorer le travail de recherche du Professeur Denis Duboule • Le prix 2011 de la Fondation pour Genève a été décerné au genevois Denis Duboule, spécialiste mondial de la génétique du développement • Dans le cadre de sa politique de soutien à la recherch