Efficacy And Safety Evaluation And The Rationality Use Analysis In Hospital Of Pantoprazole

Objective:According to the theory of evidence-based medicine(EBM), the evaluation of efficacy and security of pantoprazole is done under the guidance of EBM method. By the study of use situation and adverse reactions occurrence of pantoprazole in a tertiary general hospital, analyzing the influence factors of irrational use of drugs and security to provide a scientific basis of promoting the reasonable and secure usage for clinical,combined with the evaluation results of the literature.Methods: To retrieve databases: Pubmed database, The Cochrane Library, Embase CDDB, MEDLINE(Ovid), CBMdisc, CNKI, Wanfang data, Chinese science and technology journal full-text database(VIP), etc. Search range: database establishment –Sep.2014.According to the inclusion criteria, bring into the randomized controlled trial,system evaluation, data extraction and classification, and Meta analysis studys of efficacy and security literatures of pantoprazole. To extract and classify the index data,using the Meta analysis to evaluate the clinical efficacy and safety of pantoprazole. To extract 300 medical records of hospitalized patients who have taken the injection pantoprazole at least once of a tertiary general hospital in 2013, based on the principles of simple random sampling, investigation and study by the retrospective investigation analysis, write the questionnaire form designation. The content of questionnaire form contains basic information, medication use, clinical symptoms, and laboratory index and rationality evaluation of patients. On the basis of the evaluation index, the rational use of injection pantoprazole is evaluated comprehensively.Result: 29 clinical randomized controlled trials and 2 Meta analysis evaluations are involved, including 16 English literatures and 15 Chinese literatures. Comparison of pantoprazole group with control group contains monotherapy and combination therapy.(1) In the aspect of effectiveness for ulcer healing, both monotherapy of pantoprazole and combination therapy with antibacterial can promote the healing of ulcer with reliable curative effect. The effectiveness of pantoprazole is better than ranitidine, and has no statistic differences with omeprazole and lansoprazole. The effectiveness of pantoprazole differs from famotidine in treating duodenal bulbar ulcer in statistics,while has no statistic differences in treating gastric ulcer. Besides, the effectiveness of pantoprazole combined with amoxicillin and clarithromycin has statistic differences with that of omeprazole combined with metronidazole and clarithromycin in treating peptic ulcer.(2) In the aspect of eliminating Hp, the effectiveness of pantoprazole contrast omeprazole combined with amoxicillin and metronidazole, and contrast furazolidone combined with amoxicillin and clarithromycin has no statistic differences;pantoprazole contrast omeprazole combined with amoxicillin and clarithromycin,pantoprazole combined with amoxicillin and clarithromycin contrast omeprazole combined with metronidazole and clarithromycin, pantoprazole combined with metronidazole and clarithromycin contrast pantoprazole combined with clarithromycin has statistic differences.(3) In the aspect of symptom remission rate, pantoprazole is better than ranitidine and famotidine. The symptom remission rate is similar between pantoprazole combination group and control group. But the symptom remission rate of pantoprazole combined with amoxicillin and clarithromycin has statistic differences with omeprazole combined with metronidazole and claritheomycin after one-week treatment.(4) In the aspect of pain elimination, pantoprazole is better than ranitidine and omeprazole, and there is no difference between combination group and control group.27 researches report the adverse drug reaction/ adverse events. The main adverse reactions of pantoprazole is related to digestive system and nervous system, including nausea, vomiting, abdominal pain, constipation, dizziness, headache, agrypnia. The occurrence rate has no statistic difference between single drug group and combination drug group.Investigation and analysis of medical records shows that the department of gastroenterology use the highest ratio of injection pantoprazole in this hospital. It conform to the indication treatment indications in some degree. Dosage and DDDs have not exceeded the package insert. There are 5.66% of patients exist improper usage of menstruum. About 81.33% of patients use pantoprazole more than one week. 72.67% of patients use pantoprazole within 24 hours after been admitted to hospital. 14.67% of patients have unreasonable indication, and the ratio of unreasonable indication of the patients who have taken the endoscopy differently, compared with those who haven’t taken the endoscopy. The purpose which has the highest ratio of unreasonable indication is for vomit-stopping, and secondly is for prevention of acute gastric mucosal injury.Conclusion:In the treatment of peptic ulcer, Hp infection, remitting clinical symptoms and diminishing ulcer related pain, pantoprazole is eutherapeutic and safe. It is suitable for clinical treatment as a safe and effective antacid for peptic ulcer treatment. Since the literatures included for study are mainly Chinese, there still needs further research of pantoprazole by studying plenty of literatures which are high quality and long-term follow-up to provide reasonable and comprehensive clinical evidence. The good curative effect and security of short-term use lead to the unreasonable usage of pantoprazole in some degree. The situation of unreasonable drug usage in this hospital is similar to the existing research results, which means that the unreasonable usage of pantoprazole as a representative medicine of proton pump inhibitor, is general. The rational drug use is required according to pharmacy indication in clinic strictly.