INTRODUCTION Polypharmacy is becoming more prevalent with advances in the pharmaceutical sciences and the development of newer, though not necessarily better, drugs. One class of medications that has enjoyed steady popularity is proton pump inhibitors (PPIs), which appears near the top of many lists of the most commonly prescribed medications. (1) However, studies show that a significant number of PPI prescriptions among both inpatient and outpatient populations is often inappropriate and adds

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... o additional healthcare costs while contributing to long-term adverse effects. (2) For instance, a longitudinal study from the United States showed that 69% of PPI prescriptions lacked appropriate medical indications, contributing to a total PPI drug cost of USD 3,013,069 during the first 30 days post-discharge. (3) Similarly, another study that compared PPI usage in academic and nonacademic hospitals showed that only 39% of PPI indications were guideline-compliant. (4) Additionally, a recent study from two academic hospitals in Lima, Peru, reported an almost 54% incidence of inappropriate PPI use. (5) Although non-evidence-based indications are commonplace, not much data is available on the inappropriate use of PPIs in Asia. Given the paucity of such data in the literature, a pointprevalence study was conducted with the aim of identifying the prevalence, indications and appropriateness of PPI use in a local tertiary hospital setting in Singapore. METHODS This point-prevalence study was conducted on a randomly chosen day after we had analysed the hospital ward census records for the total number of inpatients seen from June to July 2011 across all disciplines in Tan Tock Seng Hospital, Singapore. This was done to ensure that no significant fluctuations were observed on any particular day and that the inpatient numbers on the chosen day did not fluctuate greatly from the daily average at the hospital. The total number of inpatients on the chosen day and inpatients who were on PPIs were identified via the hospital electronic medical records, which also included details pertaining to the patients' presenting complaints, duration of symptoms, salient features of the history of presenting complaints, social history, past medical history, family history, records of previous admissions, physical examination findings, investigations performed, summary of management instituted and records of previous medications prescribed by the study hospital and its affiliates (i.e. other government/restructured hospitals and healthcare facilities, excluding private institutions and general practitioners). One of the advantages of using the electronic medical records at our hospital was that all patients' previously prescribed medications and medical records from other affiliated institutions could be viewed and their indications for PPI use reviewed based on definite documentation, suggestive symptoms or indications based on clinical circumstances. For patients already on PPIs before admission, the electronic medical records allowed for a