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ANTI-ULCER MEDICATIONS USED BY 20% OF NURSING HOME PATIENTS

Executive Summary

ANTI-ULCER MEDICATIONS USED BY 20% OF NURSING HOME PATIENTS, with 59% being treated for over three months and 23% treated for more than 12 months, according to the 10,259-patient National Anti-Ulcer Therapy Surveillance Study conducted by the Center for Long-Term Care Research & Education in Chesapeake, Va. The results of the study were reported Nov. 11 by pharmacists Edgar Gonzalez and Ralph Small, Medical College of Virginia, at the American Society of Consultant Pharmacists annual meeting in New Orleans. "The fact that over half of the patients are receiving anti- ulcer therapy for three months to more than 12 months suggests that the majority of anti-ulcer therapy being prescribed in nursing homes is for maintenance therapy and to safeguard against recurrence which can often be asymptomatic and carry a high incidence of morbidity and mortality," Gonzalez said. The study, which was partially funded by Marion Merrell Dow, surveyed medication records from 83 long-term care facilities in the U.S. and found that 2,062 patients were being prescribed anti- ulcer medications. Three-fourths of those patients were women, who had a median age of 82 years. A majority of the prescriptions for anti-ulcer medication in the study were for H[2]-receptor antagonists. The researchers found that the anti-ulcer drugs were being used for the appropriate indications. Among the patients receiving anti-ulcer drugs, 79% were treated with H[2]s (Glaxo's Zantac, SmithKline Beecham's Tagamet, Merek's Pepcid or Lilly's Axid), 6% with sucralfate (Marion Merrell Dow's Carafate), 5% with sucralfate plus an H[2], 5% with omeprazole (Merck's Prilosec), 3% with misoprostol (Searle's Cytotec), and 2% received other combinations of anti-ulcer drugs. Most patients (27%) were receiving anti-ulcer therapy for gastroesophageal reflux disease (GERD), for which H[2] antagonists are indicated. Another 23% of patients were being treated for dyspepsia and 21% for peptic ulcers, which include gastric and duodenal ulcers. Sucralfate is only indicated for duodenal ulcers. The study showed all the treatments were equally effective for their indicated disease, with 72% of patients overall having a positive outcome. The proportion of patients with positive outcomes after having been treated with H[2]s was 74% compared with 70% for patients receiving sucralfate alone, and 80% for the combination of sucralfate and H[2] antagonist therapy. The study also looked at the use of concomitant therapies that might have interactions with the anti-ulcer medications. Thirty percent of the patients taking H[2] antagonists were receiving other therapies with possible drug interactions. In contrast, 7% of patients receiving sucralfate were being treated concurrently with potentially interacting drugs. The high rate of potential drug interactions for patients on H[2]s suggests that those patients may require monitoring for adverse reactions. The study also found that less than 1% of patients being treated had Helicobacter pylon infection, which has been posited as a cause of stomach ulcers.
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