Survey-Based Analysis of Current Trends for Prescribing Gastrointestinal Protectants among Small-Animal General Practitioners in Portugal

Prevalence and appropriateness of omeprazole prescription in dogs at a veterinary teaching hospital before and after the publication of the ACVIM consensus statement on the rational administration of gastrointestinal protectants

Introduction

Overprescribing of acid suppressants is a common phenomenon in human and small animal patients, leading to potential deleterious gastrointestinal (GI) and non-GI consequences. The impact of consensus statements on veterinary prescribing habits in clinical practice have not been fully evaluated. This study aimed to compare the prescribing habits of the proton pump inhibitor (PPI), omeprazole, in dogs in an academic veterinary teaching hospital before and after the publication of the American College of Veterinary Internal Medicine (ACVIM) consensus statement on rational use of gastrointestinal protectants.

Methods

Evaluation of the prescribing habits of omeprazole in dogs during the years 2017 and 2021 was retrospectively compared. These years were selected to reflect a 12-month period prior to and following the publication of the consensus statement. One hundred dogs from each year were randomly selected. Dose, frequency of administration, duration of treatment, concurrent prescription of more than one gastroprotectant and indications for prescribing omeprazole were analyzed.

Results

A significant increase in the cases that received omeprazole q12h (p < 0.0001) or that underwent a tapering dose after ≥4 week-therapy (p > 0.0001) was detected after the publication of the 2018 ACVIM consensus statement. Considering the indications, there was also a significant increase in the appropriate prescription of omeprazole in the second compared to the first period of study (p < 0.0001). Fifteen of 16 clinicians (94%) involved in the prescription of omeprazole indicated that their reading of the consensus statement had changed their clinical practice regarding PPI administration in dogs.

Discussion

These results support the beneficial impact of the ACVIM consensus statement on the judicious prescribing of omeprazole in an academic veterinary hospital. These results should not be extrapolated to first-opinion veterinary practices, and further efforts should be made to ensure that PPIs are prescribed prudently with a clear indication and regular review of the appropriateness of continued administration to minimize possible risks and adverse drug interactions.

Clinical management of feline chronic kidney disease in Portugal: a questionnaire-based study

OBJECTIVES

The aim of the study was to characterise the clinical management of feline chronic kidney disease (CKD) by veterinary practitioners in Portugal.

METHODS

A questionnaire-based study was designed to be completed by all veterinarians who had diagnosed and treated at least one case of feline CKD in the previous year.

RESULTS

A total of 409 veterinary practitioners responded to the questionnaire, with approximately half of them diagnosing 2-5 cases of feline CKD per month (n = 219, 53.5%). Although a high proportion of these reported using the guidelines published by the International Renal Interest Society (n = 379, 92.7%), only 19.1% (n = 78) systematically performed systolic blood pressure (SBP) measurements in all of their patients. A renal diet was advised by almost all respondents (n = 406, 99.3%), but 36.9% (n = 150) of them considered that it represented less than 75% of the daily food intake for most of their patients. This dietary intervention was often prescribed regardless of stage (n = 298, 73.4%) and without a proper gradual diet transition. Appetite stimulants were frequently prescribed (n = 366, 89.5%), as well as a calcium channel blocker (n = 171, 41.8%) and an angiotensin-converting enzyme inhibitor (n = 245, 59.9%) to control systemic hypertension and proteinuria, respectively. Prescription of a phosphate binder was also common (n = 311, 76.0%). Regarding monitoring, 70.9% (n = 290) recommended that stable patients be reassessed every 2-3 months or more frequently, but only 35.7% (n = 146) were able to comply with this periodicity due to owners' constraints.

CONCLUSIONS AND RELEVANCE

The findings showed that although most survey respondents are aware of international guidelines for the clinical management of cats with CKD, the SBP measurement still needs to be more systematic to allow proper substaging and detection of systemic hypertension. The monitoring frequency was lower than recommended. Furthermore, the introduction of a renal therapeutic diet should be refined to improve its acceptance rate.

Evaluation of gastroprotectant administration in hospitalized cats in a tertiary referral hospital

OBJECTIVES

The primary objective of this study was to evaluate the prescription patterns and appropriateness of the use of gastroprotectant medication in cats.

METHODS

Pharmacy dispensation logs from an academic tertiary referral center were reviewed between 1 January 2018 and 31 December 2018. Cats that were administered proton pump inhibitors (PPIs), histamine-2 receptor antagonists (H2RAs), sucralfate, misoprostol, antacids or a combination were included. Data regarding medication, dosage, formulation, duration of administration, completeness of discharge instructions and clinical rationales for administration were obtained from medical records. The appropriateness of gastroprotectant use was assessed according to the American College of Veterinary Internal Medicine consensus statement guidelines.

RESULTS

Of the 110 cases, 67 (60.9%) were prescribed a gastroprotectant medication without an appropriate indication. The most common reason for prescription was acute kidney injury in 26/67 (38.8%). PPIs were the most common gastroprotectant medication administered in 95/110 (86.3%) cats, followed by sucralfate in 18/110 (16.4%) and H2RAs in 11/110 (10%). Of the 35 cases in which gastroprotectant therapy was indicated, the medication chosen or dosage administered was considered suboptimal in 16 (45.7%). Instructions regarding the duration of administration, potential adverse effects and timing of administration in relation to meals or other medications were inconsistently provided in discharge instructions to pet owners. Of the 29 cases discharged with omeprazole, only 13 (44.8%) instructions included a duration of administration, while 6 (20.7%) recommended continuing gastroprotectants indefinitely until further notice, 16 (55.2%) discussed the timing of the administration in relation to a meal and six (20.7%) mentioned potential adverse effects; none advised tapering of omeprazole before discontinuation.

CONCLUSIONS AND RELEVANCE

When prescribed, gastroprotectant medications were frequently prescribed injudiciously to cats in this referral population over a 12-month period. Discharge instructions to pet owners also often lacked information and recommendations regarding optimal administration, potential adverse effects, and tapering or discontinuation of the medications.

Evaluation of proton pump inhibitor administration in hospitalized dogs in a tertiary referral hospital

BACKGROUND

Although proton pump inhibitors (PPIs) are commonly administered to hospitalized dogs, prescribing patterns and appropriateness of use require continued investigation.

HYPOTHESIS/OBJECTIVE

Describe prescription patterns and appropriateness of use associated with PPIs in hospitalized dogs at a single tertiary care facility. We hypothesized that the majority of prescriptions would not comply with current guidelines for the rational use of acid suppressants.

ANIMALS

Two hundred randomly selected hospitalized dogs.

METHODS

Retrospective evaluation of the medical records associated with a randomly selected sample of hospitalized dogs that received PPIs between January 2013 and December 2018.

RESULTS

A total of 12 610 dogs were admitted for first-time hospitalization between January 2013 and December 2018. Forty percent of these dogs (5062/12610) were prescribed a PPI PO or IV. Of the 200 randomly selected records, an adequate indication for use was identified in 27% of dogs (54/200). Of the dogs surviving to discharge, 54% (95/175) were discharged with a PPI and 51.6% (49/95) of those were prescribed an inadequate dose.

CONCLUSIONS AND IMPORTANCE

Our findings support other studies in which the majority of PPI prescriptions for hospitalized dogs at a tertiary care hospital lacked an appropriate indication. Furthermore, analysis of the prescribing patterns of dispensed PPIs identified a frequent occurrence of dosages considered inadequate, raising concern for ineffective treatment even with appropriate indications of use. With growing concern of adverse effects associated with PPI and other acid suppressant administration in human and veterinary medicine, rational use of these medications following consensus guidelines should be emphasized and treatment should be reserved for dogs with historical, physical examination, clinicopathologic, and imaging findings supportive of an appropriate indication for use.

Evaluation of a long-acting injectable formulation of omeprazole in healthy dogs

BACKGROUND

To evaluate the efficacy of a single intramuscular adminsitration of long-acting omeprazole (LA-OMEP) in increasing gastric pH in dogs.

HYPOTHESIS

We hypothesized that LA-OMEP would meet in healthy dogs the clinical goals defined for human patients for treatment of gastroduodenal ulceration.

ANIMALS

Nine healthy research dogs.

METHODS

Prospective experimental study. Dogs were given a 4 mg/kg intramuscular injection of LA-OMEP. Intragastric pH was continuously recorded on treatment days 0 to 7. Daily mean pH and mean percentage time (MPT) intragastric pH was ≥3 or ≥4 were determined.

RESULTS

The mean onset of action for the LA-OMEP was 98.11 min (SD 46.39). The mean number of days the dogs' pH met established goals for MPT pH ≥3 was 5.5 days (range, 3-7) and 5.25 days for MPT pH ≥4 (range, 3-7). Long-acting omeprazole met the human clinical goals pH ≥3 for 72 hours in 8/8 of the dogs and MPT pH ≥4 for 96 hours in 7/8 of dogs.

CONCLUSIONS AND CLINICAL IMPORTANCE

The LA-OMEP formulation produced gastric acid suppression in healthy dogs for an average of 5 days and up to 7 days, after a single intramuscular injection. No major adverse effects were observed.