In this study much of the inappropriate use was driven by “prophylaxis” and it was associated with an increased rate of C diff. The authors conclude:
Proton pump inhibitors are frequently inappropriately prescribed to Medicine inpatients who do not have a valid indication and this practice is associated with an increase in C. difficile infection. Interventions are needed to curtail this inappropriate prescribing practice.
Well, had it not been for some misguided performance initiatives we might not have seen this problem in the first place.
So which hospitalized patients should get pharmacologic GI prophylaxis? I haven't searched this literature but my thoughts would be COPD exacerbations and other acute respiratory illnesses when corticosteroids are given; critical patients in the ICU and MI patients who underwent urgent PCI.