Pedoman Praktik untuk Mengurangi Utilisasi Berlebih Penghambat Pompa Proton

Oleh :

dr. Nurul Falah

Suatu pedoman praktik untuk mengurangi utilisasi berlebih dari penghambat pompa proton, atau dalam bahasa Inggrisnya proton pump inhibitor (PPI) sangat dibutuhkan. Hal ini karena PPI adalah obat yang sering diresepkan secara luas pada pasien dengan gejala lambung maupun asimptomatik.

PPI seringkali diberikan pada kelainan lambung seperti dispepsia, gastritis, ulkus gaster, ulkus duodenum, gastroesophageal reflux disease (GERD), dan esofagitis. Selain itu PPI juga sering digunakan sebagai pendamping obat-obatan lain seperti asam salisilat (aspirin), obat antiinflamasi nonsteroid (OAINS) dan steroid.[1,2]

Sumber: Pexels, Pixabay, 2016.

Peresepan PPI yang berlebihan terjadi baik dari segi indikasi yang tidak sesuai maupun durasi dan dosis pemakaian yang sudah melebihi indikasi. Selain itu, mayoritas penggunaan PPI adalah swamedikasi yaitu diperoleh tanpa anjuran dan pengawasan dokter.

(Konten ini khusus untuk dokter. Registrasi untuk baca selengkapnya)

Referensi

1. Lima JJ, Thomas CD, Barbarino J, Desta Z, Van Driest SL, El Rouby N, Johnson JA, Cavallari LH, Shakhnovich V, Thacker DL, Scott SA, Schwab M, Uppugunduri CRS, Formea CM, Franciosi JP, Sangkuhl K, Gaedigk A, Klein TE, Gammal RS, Furuta T. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C19 and Proton Pump Inhibitor Dosing. Clin Pharmacol Ther. 2021 Jun;109(6):1417-1423.
2. Luo H, Fan Q, Xiao S, Chen K. Changes in proton pump inhibitor prescribing trend over the past decade and pharmacists' effect on prescribing practice at a tertiary hospital. BMC Health Serv Res. 2018;18(1):537. Published 2018 Jul 11. doi:10.1186/s12913-018-3358-5
3. Bye-bye, PPI. A tookit for deprescribing proton pump inhibitors in EMR-enabled primary care settings. Version 1.3. Choosing Wisely Canada; 2019. https://choosingwiselycanada.org/wp-content/uploads/2017/07/CWC_PPI_Toolkit_v1.2_2017-07-12.pdf
4. Zed PJ. Deprescribing Proton Pump Inhibitors. Can J Hosp Pharm. 2018;71(5):291-292.
5. Farrell B, Pottie K, Thompson W, et al. Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline. Can Fam Physician. 2017;63(5):354-364.
6. Farrell B, Pottie K, Rojas-Fernandez CH, Bjerre LM, Thompson W, Welch V. Methodology for Developing Deprescribing Guidelines: Using Evidence and GRADE to Guide Recommendations for Deprescribing. PLoS One. 2016;11(8):1-12.
7. Yap MH, Yip G, Edwards A, D’Intini V, Tong E. Appropriateness of proton pump inhibitor use in patients admitted under the general medical unit. Journal of Pharmacy Practice and Research. 2019;49(5).
8. Chan A, Liang L, Tung ACH, Kinkade A, Tejani AM. Is there a reason for the proton pump inhibitor? An assessment of prescribing for residential care patients in British Columbia. Can J Hosp Pharm. 2018;71(5):295–301.
9. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. London: National Institute for Health and Care Excellence (NICE); 2019. (NICE Clinical Guidelines, No. 184.) https://www.ncbi.nlm.nih.gov/books/NBK552570/
10. NPS Medicine Wise. PPI therapy for managing GORD. 2019. https://www.nps.org.au/assets/50240b737233cd47-a615f8d13d0c-NPS1993_SSDSM_PAP_v5.1.pdf
11. Ahmed A, Clarke JO. Proton Pump Inhibitors (PPI) [Updated 2020 May 9]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK557385/
12. Tringali A, Manta R, Sica M, Bassotti G, Marmo R, Mutignani M. Comparing intravenous and oral proton pump inhibitor therapy for bleeding peptic ulcers following endoscopic management: a systematic review and meta-analysis. Br J Clin Pharmacol. 2017;83(8):1619-1635. doi:10.1111/bcp.13258
13. Mössner J. The Indications, Applications, and Risks of Proton Pump Inhibitors. Dtsch Arztebl Int. 2016;113(27-28):477-483. doi:10.3238/arztebl.2016.0477
14. Perry IE, Sonu I, Scarpignato C, Akiyama J, Hongo M, Vega KJ. Potential proton pump inhibitor-related adverse effects. Ann N Y Acad Sci. 2020 Dec;1481(1):43-58. doi: 10.1111/nyas.14428. Epub 2020 Aug 6. Erratum in: Ann N Y Acad Sci. 2021 Mar;1487(1):74.