Most Read Articles
Roshini Claire Anthony, 4 days ago

The combined use of piperacillin and tazobactam does not appear to be a suitable alternative to meropenem for patients with bloodstream infections caused by ceftriaxone-resistant Escherichia coli (E. coli) or Klebsiella pneumoniae (K. pneumoniae), according to results of the MERINO* trial.

Tristan Manalac, 19 May 2018
Taking oral antibiotics appears to increase the risk of nephrolithiasis, according to a recent study. Moreover, the risk seems to be compounded for individuals with recent antibiotic exposure and those who were exposed at a younger age.
2 days ago
Patients with inflammatory bowel disease are at increased risk of developing acute myocardial infarction (AMI) or heart failure, although the prevalence of traditional risk factors for such cardiovascular disorders appears to be low, as reported in a recent study.
3 days ago
Early renin-angiotensin-aldosterone system (RAAS) blockade with renin-angiotensin system inhibitors (RASI) leads to better short- and long-term renal outcomes in systemic lupus erythematosus (SLE) patients with antiphospholipid-associated nephropathy (aPLN), according to a study, adding that this renal protective effect is independent of RASI’s antihypertensive and antiproteinuric effects.

What is the best route of PPI delivery in ANVGIB?

22 Aug 2017

The efficacy of scheduled intravenous (IV) proton pump inhibitors (PPIs) are comparable to that of IV PPI drip for most outcomes in acute nonvariceal upper gastrointestinal bleeding (ANVGIB), a recent systematic review and meta-analysis has found. Moreover, oral PPIs are as effective as scheduled IV for length of stay (LOS) and total units of blood transfused (UBT) and superior to IV PPI drip for risk of surgery (ROS).

Researchers identified a total of 39 studies evaluating acid suppressive medications (IV PPI drip, scheduled IV PPI, oral PPI, H2-receptor antagonists and placebo) in ANVGIB for the following endpoints: risk of rebleeding, LOS, ROS, mortality and total UBT.

Network meta-analysis and Bayesian Markov Chain Monte Carlo methods were used for indirect comparisons and for calculation of probability superiority, respectively.

There was no difference between IV PPI drip and scheduled IV PPI for mortality (relative risk [RR], 1.11; 95 percent credibility interval, 0.56 to 2.21), LOS (RR, 0.04; ‒0.49 to 0.44), ROS (RR, 1.27; 0.64 to 2.35) and risk of rebleeding within 72 hours (RR, 0.98; 0.48 to 1.95), 1 week (RR, 0.59; 0.13 to 2.03) and 1 month (RR, 0.82; 0.28 to 2.16).

In addition, oral PPIs are comparable to schedule IV PPIs and IV PPI drip for LOS (RR, 0.22; ‒0.61 to 0.79 and 0.16; ‒0.56 to 0.80) and UBT (RR, ‒0.25; ‒1.23 to 0.65 and ‒0.06; ‒0.71 to 0.65) and superior to IV PPI drip for ROS (RR, 0.30; 0.10 to 0.78).

“Conclusions should be tempered by low frequency endpoints such as ROS, but question the need for IV PPI drip in ANVGIB,” researchers said.

IV PPIs are the standard medical treatment in ANVGIB, they added.

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Roshini Claire Anthony, 4 days ago

The combined use of piperacillin and tazobactam does not appear to be a suitable alternative to meropenem for patients with bloodstream infections caused by ceftriaxone-resistant Escherichia coli (E. coli) or Klebsiella pneumoniae (K. pneumoniae), according to results of the MERINO* trial.

Tristan Manalac, 19 May 2018
Taking oral antibiotics appears to increase the risk of nephrolithiasis, according to a recent study. Moreover, the risk seems to be compounded for individuals with recent antibiotic exposure and those who were exposed at a younger age.
2 days ago
Patients with inflammatory bowel disease are at increased risk of developing acute myocardial infarction (AMI) or heart failure, although the prevalence of traditional risk factors for such cardiovascular disorders appears to be low, as reported in a recent study.
3 days ago
Early renin-angiotensin-aldosterone system (RAAS) blockade with renin-angiotensin system inhibitors (RASI) leads to better short- and long-term renal outcomes in systemic lupus erythematosus (SLE) patients with antiphospholipid-associated nephropathy (aPLN), according to a study, adding that this renal protective effect is independent of RASI’s antihypertensive and antiproteinuric effects.