Appropriateness of stress ulcer prophylaxis among older adults admitted to general medical wards in a university hospital

Introduction: There is limited evidence to support the prescription of stress ulcer prophylaxis (SUP) in general medical patients. Many studies conducted to assess this problem did not include older patients, who are more susceptible to the consequences of inappropriate SUP. This prospective study aimed to evaluate the current practice of SUP amongst older adults outside a critical care setting in a university hospital in Malaysia. Methods: All patients aged 65 and above admitted to general medical wards in our university hospital from January until March 2014 were reviewed. Patients who were newly prescribed SUP were included in the study. The American Society of Health-System Pharmacists (ASHP) guideline was used to justify appropriate indication of SUP. Results: Of 285 patients aged more than 65 years old admitted to various general medical wards, 56 patients (19.6%) received SUP. Inappropriate SUP occurred in 96.4% of patients who received SUP. Of those prescribed SUP, 35.7% received inappropriate SUP regimens in terms of administration route, dose or frequency. Among the patients, 28.6% were discharged with SUP prescription without a justified indication. Ranitidine was the most common SUP agent prescribed. Conclusion: This study demonstrates that a large number of older adult patients received inappropriate SUP. This can lead to an increase risk of medication related adverse events, drug interactions, iatrogenic adverse events related to administration of medication and increased cost to the patient and institution. Healthcare providers should be alerted of this issue and efforts need to be taken for education to reduce the incidence of unjustified SUP. 2014 Published by Elsevier Masson SAS. Available online at