Evidence-Based Recommendation by Indian Pediatric Experts on the Use of Acid-Reducing Medications in Children - Video

A recent Indian evidence-based review highlighted recommendations from a multidisciplinary team of paediatricians on the appropriate use of acid-reducing medications (ARMs) in children.

The review was published in the July 2025 issue of the journal Cureus.

Gastric acid-reducing medications (ARMs), including H2 blockers and PPIs, are essential for treating various gastrointestinal conditions in pediatric care. However, concerns over safety and widespread off-label use persist, especially in younger children, due to lack of clear, practice-based prescribing guidelines.

The Evidence-based review from Multidisciplinary team of Pediatricians on the use of gastric Acid-reducing medications in Children: Indian Perspectives (EMPACIP) study was undertaken to address these gaps by offering clear, evidence-based recommendations to guide appropriate ARM use and support informed prescribing in pediatric care.

Twenty-four pediatric specialists, including neonatologists, general pediatricians, pediatric gastroenterologists, pediatric nephrologists, a pediatric hepatologist, a pediatric pulmonologist, and a pediatric intensivist from across India, conducted a structured literature review and collaboratively evaluated ARM use and current practices.

They defined and assessed the severity of drug-induced dyspepsia using the ‘5-point Likert Scale Dyspepsia Severity Scale' via the Mentimeter platform. Among the various drug classes, NSAIDs and their combinations were identified as the most common cause of drug-induced dyspepsia, followed by Antibiotics like Amoxicillin/Clavulanic Acid, Azithromycin, Cefuroxime, Steroids like Prednisolone, and Nutritional supplements like Iron and Zinc supplements.

The following are the recommendations provided:

1. PPIs should be limited to confirmed GERD or erosive esophagitis, avoided in NICUs, and used in infants under 1 year only when clearly needed.
2. In cases of potential kidney injury, replace PPIs with H2RAs like ranitidine or famotidine, and perform routine urine tests if PPI use exceeds one week.
3. In neonates and infants, ARMs should only be used for symptomatic reflux, not for apnea alone, with H2RAs like ranitidine preferred for stress ulcer prophylaxis (SUP).
4. H2RAs like ranitidine provide rapid symptom relief, making them suitable for on-demand use, managing nocturnal acid breakthrough, and serving as step-down or rescue therapy from PPIs.
5. ARM therapy does not consistently improve asthma outcomes and should be reserved for asthmatic children with symptomatic GERD, with H2RAs like ranitidine being the safer choice.
6. ARMs should be used for drug-induced dyspepsia only when symptoms occur, stopped within 72 hours, with H2RAs like ranitidine preferred for faster relief.

These findings aim to guide primary care practitioners in adopting evidence-based ARM practices, serving as a resource for current and future paediatricians to improve patient care.

Reference: Pai UA, Ravishankar AV, Bharadia L, H R S, Wadhwa A, Prajapati B, C J, Mittal G, Belsare H, Anand K, Narayanan K, Furniturewala K, Sanklecha M, Suresh Kumar MV, Bhattacharya P, N P, Jog P, Wazir S, Soans ST, Manikanti SS, Roy S, Bhattacharyya S, Bansal U, Goswami V. Evidence-Based Review by a Multidisciplinary Team of Pediatricians on the Use of Gastric Acid-Reducing Medications in Children: Indian Perspectives. Cureus. 2025 May 7;17(5):e83653. doi: 10.7759/cureus.83653. PMID: 40486365; PMCID: PMC12143190.