Prophylactic Use Of Ranitidine in Pediatric Settings: Experts Opine

Despite the effectiveness of PPIs, they have delayed onset of action, thus limiting their on-demand use. (3) Amidst such practical challenges, the use of H2RAs such as Ranitidine have retained their clinical applicability for acid suppression in pediatric settings because of their efficacy and better safety profile. Ranitidine is effective in managing stress-induced gastric lesions in critically ill pediatric patients, reducing gastric fluid volume when used as preoperative prophylaxis, and preventing nocturnal acid reflux among pediatric patients. (1)

A gap in scientific consensus on the prophylactic application of Ranitidine in pediatric clinical settings led to the recommendations convened by thirteen Indian pediatricians and pediatric gastroenterologists based on consolidation of evidence and clinical experience. (1)

The review, which has been published in the International Journal of Contemporary Pediatrics, recommended the prophylactic use of Ranitidine in the following conditions: (1)

• Ranitidine is effective in managing stress-induced gastric lesions in critically ill pediatric patients in ICU.
• Ranitidine reduces gastric fluid volume when used as pre-operative prophylaxis.
• Ranitidine effectively prevents acid reflux at night

Ranitidine as Pre-Operative Prophylaxis: Regarding the prophylactic potential of the drug, all pediatricians and pediatric gastroenterologists unanimously agreed that the pre-operative use of Ranitidine might be considered to reduce the risk of aspiration in pediatric patients undergoing operative procedures. (1)

Speaking to Medical Dialogues, Dr. Bhaswati Acharyya, Consultant Pediatric Gastroenterologist & Hepatologist, AMRI Hospital, Kolkata, and one of the panelists in the review board said, “Gastric volume reduction is required to keep the airway passages and lungs clear from aspirating gastric contents and to avoid vomiting during anesthesia.”

Comparing the net benefit of Ranitidine and PPI for preoperative gastric volume reduction, Dr. Acharyya said, “Ranitidine might be better in reducing total gastric secretion compared to PPIs. Ranitidine can be administered pre-operatively to avoid acidulated injuries during abdominal surgery.”.

Ranitidine for Preventing Nocturnal Reflux: The recommendations noted the effectiveness of Ranitidine in preventing acid reflux at night. It further highlighted that the nocturnal use of Ranitidine is proven more effective than PPIs in preventing acid reflux at night. (1)

Elaborating on the above statements, Dr. Abhay K Shah, Senior Practicing Pediatrician and Infectious Diseases Consultant in Ahmedabad, Gujarat, said, “Nocturnal reflux is commonly encountered in the pediatric population, more so in obese patients.”

Regarding the comparative efficacy of Ranitidine and PPI for preventing nocturnal acid reflux, Dr. Shah said, “The rapid onset of action and prompt relief ensuring good sleep in nocturnal reflux cases are some of the advantages of Ranitidine over PPI in pediatric patients.”

Ranitidine in Stress-Induced Mucosal Damage: Additionally, the review highlighted the clinical applicability of Ranitidine in managing stress-induced gastric lesions in critically ill pediatric patients admitted to the ICU. (1)

Pediatric Gastroenterologist & Hepatologist, Fortis Hospitals (Fortis Gurgaon and Noida), Dr. Deepak Goyal, said-

“Stress-induced mucosal damage is common among pediatric intensive-care patients, those with acute or chronic stress, prolonged illnesses, infections, acute inflammatory states, major burns, and respiratory disorders. The lack of protective factors in the mucosal lining leads to a high risk for mucosal injury in children.”

Describing the rationale for Ranitidine use in mucosal injuries and comparing its efficacy with PPIs, Dr. Goyal said, “The rapid onset of action, optimum efficacy, and well-tolerated safety profile favour use of Ranitidine over PPIs. Also, Ranitidine action ensures it doesn’t completely suppress stomach acid, since the body needs a small quantity of stomach acid to function as a natural defense mechanism. Whereas PPIs suppress the acid to a greater extent in comparison to Ranitidine, which could have untoward repercussions for their use from the gastric first line defense standpoint.”

Reference

1. Pai UA, Kesavelu D, Shah AK, Manglik AK, Wadhwa A, Acharya B, et al. Ranitidine use in pediatrics: current evidence-based review and recommendations. Int J Contemp Pediatr 2022;9:987-97.

2. Shin JM, Sachs G. Pharmacology of proton pump inhibitors. Curr Gastroenterol Rep. 2008 Dec;10(6):528-34. 

3. Herszényi L, Bakucz T, Barabás L, Tulassay Z. Pharmacological Approach to Gastric Acid Suppression: Past, Present, and Future. Dig Dis. 2020;38(2):104-111.