Use of Proton Pump Inhibitors Without Clear Indication in Hospitalised Patients

This is the authors' abstract. We don't add key points for this paper.

Proton pump inhibitors are among the most widely prescribed medicines in hospitals, and a large share of that use has no documented indication. This review, which reports no new data, draws together published audits, trials, cohort studies and guidelines on the extent and causes of unindicated inpatient acid suppression. It covers the approved indications, the recurring patterns of overuse such as stress ulcer prophylaxis outside intensive care and unreviewed continuation at discharge, the associated harms and costs, and the stewardship measures that have been tried. Overuse is consistent across countries and specialities, whereas the harms attributed to long-term use rest largely on observational data. Few interventions have been tested with durable outcomes, and that gap limits firm practice recommendations.