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J Pharm Bioallied Sci. 2019 Jan-Mar;11(1):96-101. doi: 10.4103/jpbs.JPBS_173_18.

Appropriateness of Acid-suppressing Agents for Stress Ulcer Prophylaxis in Non-intensive Care Unit Setting in Saudi Arabia.

Author information

Pharmaceutical Care Services, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
Emergency Department, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
Department of Internal Medicine, King Fahad Medical City, Ministry of Health, Riyad, Kingdom of Saudi Arabia.
Department of Statistics, University of Karachi, Karachi, Pakistan.



To investigate the appropriateness of acid-suppressive therapy (AST) for stress ulcer prophylaxis (SUP) in noncritically ill hospitalized patients.

Materials and Methods:

A prospective, observational study with 384 subjects was conducted between October and December 2017 in the emergency and internal medicine departments. The Herzig clinical risk scoring system and the guidelines of the American Society of Health-System Pharmacists guidelines were used to assess risk factors and determine risk scores for gastrointestinal (GI) bleeding.


The mean age of subjects was 51.9 ± 19.4 years, and 220 (57.3%) of them were males. Among the absolute risk factors, coagulopathy was observed in 2 (0.5%) patients, mechanical ventilation in 15 (3.9%), and a history of GI bleeding in 1 (0.3%). Of 384 patients with SUP, 370 (96.4%) had a clinical risk score ≤ 9 and 14 (3.6%) had a risk score between 10 and 12 for nosocomial GI bleeding. A statistically significant relationship was found between the risk factor indication and demographics.


SUP is frequently administered to noncritically ill hospitalized patients lacking risk factors for GI bleeding. Proton pump inhibitors are the overwhelming first choice of AST among prescribers. Practitioners should follow international guidelines when prescribing ASTs outside the critical-care setting.


Acid-suppressing agent; prophylaxis; stress ulcer

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