Knowledge, Attitude and Practice of Physicians Toward The Prescription of Proton Pump Inhibitors in Egypt

Proton pump inhibitors (PPIs) were developed in the '80s and their use has continuously grown. They represent the first choice in the treatment of acid-related diseases and are currently themost prescribed drugs in the world [1].

In addition, PPIs have become the 8th therapeutic class on the prescription list in 2013. This impacted on health care costs especially in the last decade: in 2010, USA paid $13.9 billion for PPIs [3].

Several studies described a range of adverse events related to longterm PPI use [5,6], some of them are related to increased gastric pH which could alter intestinal bacterial flora and drugs or electrolyteabsorption. Another issue is represented by potential pharmacological interactions between PPIs and other drugs, due to interference with liver metabolic systems, and competition for renal excretion [7-16].

The huge increase in PPI use cannot be justified only by increased prevalence of acid-related diseases or extension of therapeutic indications. Some studies have shown that PPIs are often over-administered in hospital setting, inappropriately prescribed at discharge and maintained by general practitioners (GPs) [1,17,18] A recent research showed that 86% of patients who were prescribed PPIs did not have appropriate indications in the general medical ward of a tertiary Jordanian hospital [2]. Another study showed that PPI were taken by 25.4% of the patients hospitalized in an internal medicine department of a tertiary Greek hospital, but as many as 81.2% of them had no indications [11].

However, the knowledge and practice of physicians in Egypt toward the use of PPI is not well studied.