Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Department of Clinical Haematology, Austin Hospital, Melbourne, Victoria, Australia.
Intern Med J. 2019 Jun;49(6):694-701. doi: 10.1111/imj.14241.
While proton pump inhibitors (PPI) are widely prescribed as prophylaxis in selected haematology inpatient and outpatients, an informal survey of haematology units around Australia found wide variations in the specific indications for their use. This is consistent with a literature review which showed a paucity of robust evidence to support their use, specifically in chemotherapy-induced mucositis, thrombocytopenia or administration of high dose glucocorticosteroids in the absence of additional risk factors. Rationalising PPI prescribing is clinically important from both a cost and safety perspective, given the emerging evidence of adverse events associated with prolonged PPI administration. A review of prescribing practices at our institution over a 14-month period found that approximately 60% of myeloma, lymphoma and autograft patients received PPI prophylaxis during and beyond chemotherapy without an accepted indication. We encourage institutions to review their PPI prescribing practices with the intent of rationalising their use, and to conduct studies aiming to fill the substantial gaps in our knowledge.
质子泵抑制剂（PPI）被广泛用于某些血液科住院和门诊患者的预防治疗，但澳大利亚各地血液科单位的一项非正式调查发现，其使用的具体适应症存在很大差异。这与文献综述结果一致，即缺乏有力证据支持其使用，特别是在化疗引起的粘膜炎、血小板减少症或在没有其他危险因素的情况下使用大剂量糖皮质激素时。鉴于与长期使用 PPI 相关的不良事件的新证据，从成本和安全角度来看，合理化 PPI 处方具有重要的临床意义。我们机构对 14 个月期间的处方实践进行了审查，发现大约 60%的骨髓瘤、淋巴瘤和自体移植患者在化疗期间和之后接受了 PPI 预防治疗，但没有得到认可的适应症。我们鼓励各机构审查其 PPI 处方实践，以合理化其使用，并开展旨在填补我们知识空白的研究。
