Title: PPI Bolus + Infusion vs. Intermittent Bolus for Upper GI Hemorrhage<br/>Author: Daniel Haase<br/><a href='http://umem.org/profiles/faculty/1447/'>[Click to email author]</a><hr/><ul>
<li>
Current guidelines recommend IV proton pump inhibitors in setting of acute upper GI hemorrhage as a bolus + infusion (e.g. 80 mg bolus + 8mg/hr infusion).</li>
<li>
Recent meta-analysis comparing bolus + infusion versus intermittent bolus (most commonly 40 mg BID) demonstrated non-inferiority of intermittent bolus dosing.</li>
<li>
In fact, there was a trend (though not significant) to superiority of intermittent bolus dosing, with decreases in rebleeding, mortality, repeat intervention.</li>
<li>
From a practical standpoint, pantoprazole requires a dedicated IV line, and is not compatible with other common ICU infusions (fentanyl, propofol, norepinephrine, octreotide).</li>
</ul>
<fieldset><legend>References</legend>
<p>
1. <span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; line-height: 16.6152px;">Laine L, Jensen DM. </span><a href="http://www-ncbi-nlm-nih-gov.proxy-hs.researchport.umd.edu/pubmed/22310222" style="color: rgb(100, 42, 143); border: 0px; font-family: arial, helvetica, clean, sans-serif; line-height: 16.6152px;">Management of patients with ulcer bleeding.</a><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; line-height: 16.6152px;"> Am J Gastroenterol. 2012 Mar;107(3):345-60; quiz 361. doi: 10.1038/ajg.2011.480. Epub 2012 Feb 7. Review. PubMed PMID: 22310222.</span></p>
<p>
2. <span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; line-height: 16.6152px;">Barkun AN, et al; International Consensus Upper Gastrointestinal Bleeding Conference Group. </span><a href="http://www-ncbi-nlm-nih-gov.proxy-hs.researchport.umd.edu/pubmed/20083829" style="color: rgb(100, 42, 143); border: 0px; font-family: arial, helvetica, clean, sans-serif; line-height: 16.6152px;">International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding.</a><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; line-height: 16.6152px;"> Ann Intern Med. 2010 Jan 19;152(2):101-13. doi: 10.7326/0003-4819-152-2-201001190-00009. PubMed PMID: 20083829.</span></p>
<p>
<span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; line-height: 16.6152px;">3. Sachar H, Vaidya K, Laine L. </span><a href="http://www-ncbi-nlm-nih-gov.proxy-hs.researchport.umd.edu/pubmed/25201154" style="color: rgb(100, 42, 143); border: 0px; font-family: arial, helvetica, clean, sans-serif; line-height: 16.6152px;">Intermittent vs continuous proton pump inhibitor therapy for high-risk bleeding ulcers: a systematic review and meta-analysis.</a><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; line-height: 16.6152px;"> JAMA Intern Med. 2014 Nov;174(11):1755-62. doi: 10.1001/jamainternmed.2014.4056. Review. PubMed PMID: 25201154; PubMed Central PMCID: PMC4415726.</span></p>
<p>
<span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; line-height: 16.6152px;">4. Neumann I, et aI. </span><a href="http://www-ncbi-nlm-nih-gov.proxy-hs.researchport.umd.edu/pubmed/23760821" style="color: rgb(100, 42, 143); border: 0px; font-family: arial, helvetica, clean, sans-serif; line-height: 16.6152px;">Comparison of different regimens of proton pump inhibitors for acute peptic ulcer bleeding.</a><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; line-height: 16.6152px;"> Cochrane Database Syst Rev. 2013 Jun 12;(6):CD007999. doi: 10.1002/14651858.CD007999.pub2. Review. PubMed PMID: 23760821. </span></p>
<p>
<span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; line-height: 16.6152px;">5. Pantoprazole. Micromedex 2.0. Truven Health Analytics, Inc. Available at http://micromedexsoultsions. Accessed June 7, 2016.</span></p>
</fieldset>