Prescribing patterns and determinants of long-term proton pump inhibitor use in Malaysian public hospitals

Abstract

Objectives

This study aimed to evaluate the prescribing patterns and determinants of long-term proton pump inhibitor (PPI) therapy across four public hospitals in Malaysia.

Methods

Adult inpatients aged ≥18 years old and who received PPIs during medical ward admission in 2023 were recruited as respondents, whereas adult inpatients who were pregnant, prescribed PPIs for Zollinger–Ellison syndrome, Barrett's esophagus, or Helicobacter pylori eradication, or with incomplete data were excluded.

Results

In total, 392 adult inpatients with PPI prescriptions in 2023 were included. The mean age was 66.7 years, with most patients aged ≥60 years (76.5%) and predominantly male (75%). Pantoprazole was the most frequently prescribed (83.7%), and only 29.6% had documented indications. Long-term PPI therapy over 12 weeks was observed in 87.5% of patients and 71.4% received continuous therapy. Laboratory analyses also found significant reductions in serum magnesium and hemoglobin post-PPI therapy (p < 0.001), whereas changes in pre- and post-corrected calcium levels (p = 0.115) were not significant. In addition, multivariate logistic regression analysis identified the number of received medications as the only independent predictor of long-term PPI use over 12 weeks (odds ratio = 1.913, 95% confidence interval: 1.525–2.398, p < 0.001).

Conclusions

Long-term PPI therapy beyond 12 weeks was highly prevalent in Malaysian public hospitals, and predominantly driven by the number of medications received by patients. These findings highlight the need to rationalize PPI prescribing and implement strategies to optimize patient safety.