PMID- 38046478
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231205
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 10
DP  - 2023 Oct
TI  - Comparison Between Pantoprazole Intermittent Dosing and Continuous Infusion in 
      Suspected Upper Gastrointestinal Bleeding Prior to Endoscopy: Impact of a 
      Pharmacist-Driven Protocol to Reduce Utilization of Pantoprazole Continuous 
      Infusion.
PG  - e48056
LID - 10.7759/cureus.48056 [doi]
LID - e48056
AB  - BACKGROUND: Current practice for patients with suspected or confirmed upper 
      gastrointestinal bleeding (GIB) is to utilize a proton pump inhibitor (PPI) bolus 
      followed by a continuous infusion for 72 hours. Literature has shown similar 
      outcomes with intermittent bolus dosing compared to continuous infusion. 
      Substitution would lead to reduced costs and utilization of resources. METHODS: 
      This was a retrospective case-control study conducted via chart review. Utilizing 
      electronic healthcare record reports, patients in the control arm were screened 
      for inclusion if they received a pantoprazole continuous infusion from December 
      1, 2020, to March 31, 2021. A total of 38 patients were included in the control 
      arm. Patients in the experimental arm were screened for inclusion with 
      pantoprazole intermittent therapy from January 1, 2022, to June 30, 2022. A total 
      of 60 patients were included in the experimental arm. The primary outcome was a 
      30-day GIB recurrence. Secondary outcomes included 30-day hospital readmission, 
      30-day Clostridioides difficile (C. difficile), hospital length of stay (LOS), 
      and number of pantoprazole vials utilized. RESULTS: There was a 65% reduction in 
      the 30-day GIB recurrence in the intermittent bolus arm compared to the 
      continuous infusion arm. Thirty-day hospital readmission was 57% lower in the 
      intermittent bolus arm compared to the continuous infusion arm. The LOS between 
      the two arms was almost identical with the median being five days for the 
      intermittent bolus arm and the median being four days for the continuous infusion 
      arm. The 30-day C. difficile infection rate had 5% of patients acquiring C. 
      difficile in the intermittent bolus arm and 2.5% in the continuous infusion arm. 
      The intermittent bolus arm used 55% fewer pantoprazole vials than the continuous 
      infusion arm. CONCLUSION: In hospitalized patients, the utilization of 
      pantoprazole intermittent bolus is not only comparably efficacious but 
      potentially represents a safer and economically advantageous alternative compared 
      to the current guideline recommendation of a 72-hour pantoprazole continuous 
      infusion. Further studies could provide more robust data to support our findings 
      and challenge the current recommendation for patients who meet the indication 
      criteria.
CI  - Copyright (c) 2023, Hernandez et al.
FAU - Hernandez, Ivan A
AU  - Hernandez IA
AD  - Pharmacy, Baptist Health South Florida, Miami, USA.
FAU - Morell, Jason
AU  - Morell J
AD  - Pharmacy, Baptist Health South Florida, Miami, USA.
FAU - Mulcahy, Lauren
AU  - Mulcahy L
AD  - Pharmacy, Baptist Health South Florida, Miami, USA.
FAU - Luzardo, Daniela
AU  - Luzardo D
AD  - Pharmacy, University of Florida, Miami, USA.
LA  - eng
PT  - Journal Article
DEP - 20231031
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC10688605
OTO - NOTNLM
OT  - acute gastrointestinal bleed
OT  - clinical pharmacist
OT  - gastroenterology and endoscopy
OT  - proton pump inhibitor
OT  - s: acute variceal upper gastrointestinal bleed
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/12/04 06:42
MHDA- 2023/12/04 06:43
PMCR- 2023/10/31
CRDT- 2023/12/04 05:00
PHST- 2023/10/31 00:00 [accepted]
PHST- 2023/12/04 06:43 [medline]
PHST- 2023/12/04 06:42 [pubmed]
PHST- 2023/12/04 05:00 [entrez]
PHST- 2023/10/31 00:00 [pmc-release]
AID - 10.7759/cureus.48056 [doi]
PST - epublish
SO  - Cureus. 2023 Oct 31;15(10):e48056. doi: 10.7759/cureus.48056. eCollection 2023 
      Oct.