The NHS could save £50m ($75m) a year if GPs were more circumspect in their use of proton pump inhibitors, the National Institute for Clinical Excellence said in its guidance to doctors last week.
The institute asked doctors to review their use of these drugs with the aim of reducing the dose or even stopping the medicine when appropriate. The NHS in England and Wales spent £314m on proton pump inhibitors in 1998. If the guidance were implemented it could reduce use by 15% the institute said.
It recommends that patients diagnosed with non-ulcer dyspepsia should not be routinely prescribed proton pump inhibitors. If the symptoms seem to be acid related, an antacid or the lowest dose of an acid suppressor to control symptoms should be prescribed.
If the symptoms do not seem to be acid related, an alternative therapeutic strategy should be prescribed, the guidance says.
Patients with documented duodenal or gastric ulcers should be tested for infection with Helicobacter pylori, and, when positive, they should be treated with eradication therapy. They should not be treated with long term, acid suppressing therapy.
For patients with ulcers induced by non-steroidal anti-inflammatory drugs who have to continue taking these drugs, an acid suppressor (usually a proton pump inhibitor) should be prescribed. After the ulcer has healed, however, treatment should be reduced gradually to a maintenance dose.
Patients with severe symptoms of gastro-oesophageal reflux disorder should be treated with a healing dose until the symptoms have been controlled. After that the dose should be reduced gradually to the lowest dose that maintains symptom control.
Copies of the full guidance and information for patients are available on the NICE website (www.nice.org.uk).