Assessment of the appropriateness of stress ulcer prophylaxis practice among hospitalized patients across Lebanese hospitals: A multicenter prospective study

BACKGROUND: Stress ulcer prophylaxis (SUP) is recommended for critically ill patients at high risk of stress-related gastrointestinal bleeding. Despite established guideline recommendations, inappropriate use of acid suppressant medications (ASMs), particularly proton pump inhibitors (PPIs), remains common worldwide and may expose patients to unnecessary adverse effects and increased healthcare costs. This study aimed to assess the appropriateness of SUP prescribing practices among hospitalized patients across Lebanese hospitals, focusing on indication, choice of pharmacologic agent, dosing regimen, route of administration, duration of therapy, discharge prescribing, and factors associated with inappropriate SUP practice. METHODS: A multicenter prospective study was conducted between April 20 and May 22, 2026, across ten tertiary-care hospitals in different regions of Lebanon. Adult patients (≥18 years) admitted to Internal Medicine Unit, Intensive Care Unit (ICU), or Coronary Care Unit wards were assessed for the appropriateness of SUP, regardless of whether ASMs were prescribed. The appropriateness of SUP practice was evaluated according to the Society of Critical Care Medicine and American Society of Health-System Pharmacists (SCCM/ASHP) 2024 and ASHP 1999 guidelines. Multivariable logistic regression was performed to identify factors associated with inappropriate SUP practice. RESULTS: A total of 552 patients were enrolled, with a mean age of 64.3 ± 18.5 years, and 58.7% were male. According to the SCCM/ASHP 2024 and ASHP 1999 guidelines, 90.8% and 77.2% of patients, respectively, were not eligible for SUP. Omeprazole was the most frequently prescribed agent (75.4%), and PPIs were used in all SUP prescriptions. Among patients admitted to ICU, 11.2% continued receiving ASMs after the SUP indication had resolved or following ICU transfer without a persisting indication. Overall, SUP practice was inappropriate in 77.9% of patients. Multivariable analysis demonstrated that anticoagulant therapy was associated with higher odds of inappropriate SUP practice (AOR = 2.78, 95% CI = 1.35-5.74, P = 0.006). CONCLUSIONS: Inappropriate SUP practice is highly prevalent among hospitalized patients in Lebanon, largely due to prescribing without guideline-based indications. Inappropriate continuation after resolution of the SUP indication or ICU transfer was also observed. Strengthening adherence to evidence-based recommendations through stewardship programs, prescribing audits, standardized protocols, and updated national guidance may help optimize SUP use and improve patient care.