Focus On: Co-prescribing Probiotics and Prebiotics with PPIs in India - Five Commandments

Published in the latest December issue of JAPI, the survey included 1007 health care professionals (HCPs) from across India. Based on consensus results, panelists recommended five commandments.

1. Perform a thorough clinical evaluation before prescribing PPIs (level 1)

2. Prescribe PPIs for a short-term duration (≤8 weeks). If long-term therapy is prescribed, reassess the need for continuation periodically and attempt to taper or discontinue if possible (level 2)

3. Educate patients about potential side effects associated with long-term PPI use, especially abnormal bowel habits, bloating, micronutrient deficiencies, flatulence, and abdominal pain (level 2)

4. Co-prescribe pre- and probiotics with PPIs when managing patients with Antibiotic-associated diarrhoea, and those experiencing abnormal bowel habits, bloating (level 1), micronutrient deficiencies, flatulence, and abdominal pain (level 2)

5. Consider co-prescribing pre- and probiotics for >3 months to achieve favorable outcomes and improve overall quality of life (level 1), while monitoring and assessing their effectiveness regularly.

PPI: proton-pump inhibitor

Level 1: >50% agreed; level 2: 30-50% HCPs agreed

Also check part 1: https://medicaldialogues.in/news/insights-into-co-prescribing-probiotics-and-prebiotics-with-ppis-in-india-122022

Adapted from:

Kalra S et al. The Scope of Pre- and Probiotics as an Add-on to Proton-pump Inhibitors in Various Clinical Indications. J Assoc Physicians India 2023;https://doi.org/10.59556/ japi.71.0409