Inappropriate prescribing of proton pump inhibitors among patients in two Jordanian tertiary health facilities

Purpose: To evaluate the current prescription pattern and appropriateness of proton pump inhibitors (PPIs) in two of the largest tertiary hospitals in Jordan, and also to determine their utilization rate among the admitted patients.Methods: A retrospective cross-sectional study was conducted over 10 months (February-November 2013) at two Jordanian tertiary hospitals. A total of 193 patients, both in intensive care unit (ICU) and non-ICU, who were receiving PPIs prescriptions as part of their drug regimen during their hospitalization, were recruited. Patients were accessed from different hospitals’ wards (non-ICU and ICU) using a convenient sampling technique. The appropriateness of PPIs and the rationale for their prescription as a treatment or prevention therapy were evaluated according to the recent treatment guidelines.Results: The results showed that PPIs were being overused; only 53 patients (27.5 %) were prescribed PPIs for a correct indication, while the remaining 140 patients (72.5 %) were receiving PPIs without any documented valid indication. By comparing the patients according to their site of care, 52.4 % (43/82) of ICU patients compared to 87.4 % (97/111) of medically hospitalized patient (non-ICU) were inappropriately receiving PPIs (p = 0.000).Conclusion: Adherence to the current practice guidelines for safe prescription of PPIs is poor. Thus, updating physicians on the practice guidelines, participation of a clinical pharmacist in making therapeutic decisions and modifying hospital formularies are measures that would be helpful and thus contribute to improved healthcare in Jordan.Keywords: NSAID-induced ulcer, Overuse of medications, Proton pump inhibitor, Stress ulcer, Intensive care uni

Population pharmacokinetics of vancomycin in Jordanian patients

Purpose: To characterize vancomycin pharmacokinetic properties in a Jordanian population and identify patients’ characteristics that influence vancomycin disposition.Method: A non-linear mixed-effects modeling was applied to evaluate vancomycin population pharmacokinetic parameters in Jordanian patients using NONMEM software. Vancomycin concentrations were obtained retrospectively from patients’ medical records. Demographic, clinical, medication-related, and medical history data were collected and examined as potential predictors of vancomycin disposition.Results: A total of 164 plasma vancomycin measurements from 110 patients, including neonates, older children and adults were collected. Vancomycin pharmacokinetics was described using a onecompartment model. Based on NONMEM objective function value, the selection of other models (e.g., two or three compartments) did not improve the performance of the pharmacokinetic model. Identified predictors of vancomycin clearance include: weight, serum creatinine, chronic renal failure, acute kidney injury and gender. Vancomycin volume of distribution was associated with weight and n-acetylcystine administration.Conclusion: The present analysis is a preliminary step toward developing a vancomycin dosing algorithm in Jordanian population.Keywords: Vancomycin, Population pharmacokinetics, NONME