Study finds frequent inappropriate ulcer-prevention medicine use in Ethiopian ICUs
A prospective study of 229 critically ill patients found prescribing problems before, during and after intensive care.
Low evidenceHuman studyInterpret with caution
Medical disclaimer: This article summarizes research findings and is for informational purposes only. It is not medical advice.
Editorial illustration — not from the study.
The study followed critically ill patients admitted between September and November 2021. Researchers compared prescribing with criteria from American Society of Health-System Pharmacists guidelines, classifying use as appropriate or inappropriate at admission, during the ICU stay and at discharge.
Inappropriate use was reported for 38.9% of patients at or before admission, 56.8% during the ICU stay and 34.2% at discharge. Overall, 24.8% of patients were discharged with unnecessary prophylaxis. The researchers also reported statistical associations involving age and acute pancreatitis, but these findings require cautious interpretation because the study was small and observational.
The question examined
Researchers examined how often stress ulcer prophylaxis was used inappropriately and which patient factors were associated with that use. The study was a multicenter prospective observational study conducted in three public hospital ICUs in Addis Ababa from September through November 2021. It included all critically ill patients who stayed at least 24 hours and received at least one medicine; 229 patients were included, and 32.8% were children. Appropriateness was assessed using guideline criteria, including whether prophylaxis was used without an indication, omitted when an indication was present, or unnecessarily continued at discharge.
Key observations
The researchers reported inappropriate prophylaxis use in 89 patients, or 38.9%, at or before admission; 130 patients, or 56.8%, during the ICU stay; and 51 patients, or 34.2%, at discharge. They reported that 24.8% of patients left the hospital with unnecessary prophylaxis. During the ICU stay, overuse without an indication accounted for 14.8% of inappropriate use, while underuse despite an indication occurred in 16.6%.
In adjusted analyses, age 65 or older was statistically associated with appropriate prophylaxis use at admission and during the ICU stay. Acute pancreatitis was the only reported independent predictor of inappropriate use at discharge, with the reported association requiring cautious interpretation because of the small sample size. These are associations, not proof that age, pancreatitis or prescribing practices caused a particular outcome.
Who this is relevant to
These findings may be most relevant to prescribing practices in public hospital ICUs with patient populations and resources similar to the three facilities studied in Addis Ababa. They should not be assumed to represent all Ethiopian hospitals, other countries, outpatient care or patients who are not critically ill. The study describes associations in a specific healthcare setting and does not establish that changing prophylaxis use would improve outcomes.
The significance
The study highlights that prescribing of ulcer-prevention medicines may not consistently match guideline criteria in the three Ethiopian public ICUs examined. Unnecessary or inappropriate use can expose patients to medicines without a clear indication and may increase costs or the possibility of adverse effects. However, this study measured prescribing appropriateness rather than directly demonstrating changes in pneumonia, Clostridioides difficile infection, medication-related harm or other clinical outcomes.
Limitations & evidence assessment
The study was observational, so it cannot establish cause and effect or show that inappropriate prophylaxis caused patient harm. It included only 229 patients from three public ICUs in Addis Ababa and collected data over a short period in 2021, which may limit how well the findings apply to other hospitals, regions or time periods. The sample included both adults and children, and the abstract provides limited detail about how these groups and individual illnesses were analyzed. The reported association involving acute pancreatitis should be interpreted cautiously, as the researchers themselves noted the small sample size. The abstract does not provide enough information to assess other possible limitations, such as loss to follow-up or variation in prescribing between hospitals.
Why this evidence level: This was a prospective observational study of 229 critically ill patients in three public hospital intensive care units. It can describe prescribing patterns and statistical associations, but it cannot establish that any factor caused inappropriate use, and the sample and setting were limited.
Evidence levels are editorial estimates derived from study metadata — they are not clinical appraisals.
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