Medical Dialogues
  • Dermatology
Login Register
This site is intended for healthcare professionals only
Login Register
  • MD Brand Connect
  • Vaccine Hub
  • MDTV
    • Breaking News
    • Medical News Today
    • Health News Today
    • Latest
    • Journal Club
    • Medico Legal Update
    • Latest Webinars
    • MD Shorts
    • Health Dialogues
  • Fact Check
  • Health Dialogues
Medical Dialogues
  • Medical News & Guidelines
      • Anesthesiology
      • Cardiology and CTVS
      • Critical Care
      • Dentistry
      • Dermatology
      • Diabetes and Endocrinology
      • ENT
      • Gastroenterology
      • Medicine
      • Nephrology
      • Neurology
      • Obstretics-Gynaecology
      • Oncology
      • Ophthalmology
      • Orthopaedics
      • Pediatrics-Neonatology
      • Psychiatry
      • Pulmonology
      • Radiology
      • Surgery
      • Urology
      • Laboratory Medicine
      • Diet
      • Nursing
      • Paramedical
      • Physiotherapy
  • Health news
      • Doctor News
      • Government Policies
      • Hospital & Diagnostics
      • International Health News
      • Medical Organization News
      • Medico Legal News
      • NBE News
      • NMC News
  • Fact Check
      • Bone Health Fact Check
      • Brain Health Fact Check
      • Cancer Related Fact Check
      • Child Care Fact Check
      • Dental and oral health fact check
      • Diabetes and metabolic health fact check
      • Diet and Nutrition Fact Check
      • Eye and ENT Care Fact Check
      • Fitness fact check
      • Gut health fact check
      • Heart health fact check
      • Kidney health fact check
      • Medical education fact check
      • Men's health fact check
      • Respiratory fact check
      • Skin and hair care fact check
      • Vaccine and Immunization fact check
      • Women's health fact check
  • AYUSH
    • Ayurveda
    • Homeopathy
    • Siddha
    • Unani
    • Yoga
  • State News
      • Andaman and Nicobar Islands
      • Andhra Pradesh
      • Arunachal Pradesh
      • Assam
      • Bihar
      • Chandigarh
      • Chattisgarh
      • Dadra and Nagar Haveli
      • Daman and Diu
      • Delhi
      • Goa
      • Gujarat
      • Haryana
      • Himachal Pradesh
      • Jammu & Kashmir
      • Jharkhand
      • Karnataka
      • Kerala
      • Ladakh
      • Lakshadweep
      • Madhya Pradesh
      • Maharashtra
      • Manipur
      • Meghalaya
      • Mizoram
      • Nagaland
      • Odisha
      • Puducherry
      • Punjab
      • Rajasthan
      • Sikkim
      • Tamil Nadu
      • Telangana
      • Tripura
      • Uttar Pradesh
      • Uttrakhand
      • West Bengal
  • Medical Education
      • Ayush Education News
      • Dentistry Education News
      • Medical Admission News
      • Medical Colleges News
      • Medical Courses News
      • Medical Universities News
      • Nursing education News
      • Paramedical Education News
      • Study Abroad
  • Industry
      • Health Investment News
      • Health Startup News
      • Medical Devices News
      • Pharma News
      • Pharmacy Education News
      • Industry Perspective
  • MDTV
      • Health Dialogues MDTV
      • Health News today MDTV
      • Latest Videos MDTV
      • Latest Webinars MDTV
      • MD shorts MDTV
      • Medical News Today MDTV
      • Medico Legal Update MDTV
      • Top Videos MDTV
      • Health Perspectives MDTV
      • Journal Club MDTV
      • Medical Dialogues Show
This site is intended for healthcare professionals only
LoginRegister
Medical Dialogues
LoginRegister
  • Home
  • Medical news & Guidelines
    • Anesthesiology
    • Cardiology and CTVS
    • Critical Care
    • Dentistry
    • Dermatology
    • Diabetes and Endocrinology
    • ENT
    • Gastroenterology
    • Medicine
    • Nephrology
    • Neurology
    • Obstretics-Gynaecology
    • Oncology
    • Ophthalmology
    • Orthopaedics
    • Pediatrics-Neonatology
    • Psychiatry
    • Pulmonology
    • Radiology
    • Surgery
    • Urology
    • Laboratory Medicine
    • Diet
    • Nursing
    • Paramedical
    • Physiotherapy
  • Health news
    • Doctor News
    • Government Policies
    • Hospital & Diagnostics
    • International Health News
    • Medical Organization News
    • Medico Legal News
    • NBE News
    • NMC News
  • Fact Check
    • Bone Health Fact Check
    • Brain Health Fact Check
    • Cancer Related Fact Check
    • Child Care Fact Check
    • Dental and oral health fact check
    • Diabetes and metabolic health fact check
    • Diet and Nutrition Fact Check
    • Eye and ENT Care Fact Check
    • Fitness fact check
    • Gut health fact check
    • Heart health fact check
    • Kidney health fact check
    • Medical education fact check
    • Men's health fact check
    • Respiratory fact check
    • Skin and hair care fact check
    • Vaccine and Immunization fact check
    • Women's health fact check
  • AYUSH
    • Ayurveda
      • Ayurveda Giuidelines
      • Ayurveda News
    • Homeopathy
      • Homeopathy Guidelines
      • Homeopathy News
    • Siddha
      • Siddha Guidelines
      • Siddha News
    • Unani
      • Unani Guidelines
      • Unani News
    • Yoga
      • Yoga Guidelines
      • Yoga News
  • State News
    • Andaman and Nicobar Islands
    • Andhra Pradesh
    • Arunachal Pradesh
    • Assam
    • Bihar
    • Chandigarh
    • Chattisgarh
    • Dadra and Nagar Haveli
    • Daman and Diu
    • Delhi
    • Goa
    • Gujarat
    • Haryana
    • Himachal Pradesh
    • Jammu & Kashmir
    • Jharkhand
    • Karnataka
    • Kerala
    • Ladakh
    • Lakshadweep
    • Madhya Pradesh
    • Maharashtra
    • Manipur
    • Meghalaya
    • Mizoram
    • Nagaland
    • Odisha
    • Puducherry
    • Punjab
    • Rajasthan
    • Sikkim
    • Tamil Nadu
    • Telangana
    • Tripura
    • Uttar Pradesh
    • Uttrakhand
    • West Bengal
  • Medical Education
    • Ayush Education News
    • Dentistry Education News
    • Medical Admission News
    • Medical Colleges News
    • Medical Courses News
    • Medical Universities News
    • Nursing education News
    • Paramedical Education News
    • Study Abroad
  • Industry
    • Health Investment News
    • Health Startup News
    • Medical Devices News
    • Pharma News
      • CDSCO (Central Drugs Standard Control Organisation) News
    • Pharmacy Education News
    • Industry Perspective
  • Home
  • Pediatrics and Neonatology
  • Pediatrics and Neonatology Perspective
  • Discourage Use of...

Discourage Use of Proton Pump Inhibitors in Children Below 1 Year of Age: Guidelines from Indian Society of Gastroenterology

Written By : Dr. Kamal Kant Kohli Published On 2023-09-25T11:15:12+05:30  |  Updated On 25 Sept 2023 4:39 PM IST
Discourage Use of Proton Pump Inhibitors in Children Below 1 Year of Age: Guidelines from Indian Society of Gastroenterology
  • facebook
  • twitter
  • linkedin
  • whatsapp
  • Telegram
  • Email

The use of PPIs should be discouraged among children below 1 year of age, as per the latest Indian Guidelines recommending optimization with the use of PPI (Proton Pump Inhibitors). The recommendations also suggest against the routine co-prescribing of PPIs with antibiotics.

The guidelines are published online in the September 2023 issue of the Indian Journal of Gastroenterology, and are formulated to rationalize the use of PPIs. This paper represents the guidelines in detail, including statements, a review of the literature, a level of evidence, and recommendations. The guideline aims to help clinicians optimize the use of PPIs in their clinical practice and, importantly, emphasize PPI stewardship.

Discourage Use of PPIs Among Infants: What’s the Science Behind?

The guideline issued strongly condemns the use of PPIs in children below one year of age as a “Strong” strength of recommendation with “good clinical practice” based level of evidence. This advice arises from considerations of age-specific dosing and associated potential risks.

Infants and younger children often require higher doses of PPIs due to faster metabolism; however, it should not exceed the higher end of the dose used in adults.

It is obligatory to exercise restraint and avoid prescribing PPIs to children below one year of age due to their developing physiological systems and limited evidence supporting their efficacy in this age group. Studies have raised concerns about potential long-term effects on bone health, altered gut microbiota, and increased risk of infections associated with PPI usage in children.

The guideline further noted that the dose-related effects of PPIs have not been validated appropriately in newborns, and certain enzymes involved in their clearance take five to six months to attain maturation of activity. Recommendations from various society guidelines re-iterate the ineffectiveness of PPI for symptoms usually attributed to GERD (Gastroesophageal Reflux Disease) in otherwise healthy infants, such as sleep disturbance, irritability, or unexplained crying. Also, evidence of supporting PPI trials for the diagnosis of extra-esophageal symptoms of GERD and use beyond the management of erosive esophagitis or acid reflux symptoms is lacking in the pediatric population.

Co-prescribing PPI with Antibiotics: Need to Be Cautious

These guidelines bring out evidence-based recommendations suggesting routine co-prescription of PPIs with antibiotics is not needed as a “Strong” strength of recommendation.

According to the guidelines, it is advised to avoid routine co-prescription of Proton Pump Inhibitors (PPIs) alongside antibiotics, except for Helicobacter pylori eradication therapy. Combining antibiotics and PPIs heightens the risk of Clostridiodes difficile infection (CDI)-related diarrhea, as substantiated in pre-clinical and clinical studies. This combination can lead to alterations in gut microbiota, further increasing the risk of CDI. A population-based study demonstrated a higher likelihood of CDI-associated diarrhea in individuals using antibiotics alongside PPIs. This depicts the need for careful consideration when combining these medications.

Other Recommendations and Considerations Regarding Optimal Use of PPIs in Clinical Practice:
  • Routine Use of Fixed-dose Combination Therapy of PPIs with Prokinetic Agents Not Recommended in GERD: PPIs are frequently used in combination with prokinetics to treat GERD by increasing stomach emptying, peristalsis, and lower esophageal sphincter pressure. However, it must be well-established to support the regular use of such a combination. Prokinetics may be used in addition to PPIs for symptoms similar to dysmotility and an insufficient PPI response. The recommendations of the Indian Society of Gastroenterology (ISG) and the American College of Gastroenterology (ACG) prohibit routine prokinetic use in GERD patients without objective gastroparesis evidence. Similarly, prokinetics are not suggested in GERD management guidelines for healthy children with isolated regurgitation.
  • Routine Use of PPIs with Selective Serotonin Reuptake Inhibitors (SSRIs) is Not Recommended: Gastrointestinal (GI) bleeding is more prevalent when SSRIs are prescribed. In one meta-analysis, when SSRIs and NSAIDs are used together, co-prescribing acid-suppressing medicines reduces this risk, but not when SSRIs are used alone. However, recommendations regarding PPI/antisecretory medicines should be individualized due to significant interactions and potential adverse effects, particularly in individuals taking multiple medications or suffering from comorbid conditions.
  • Routine Use of PPIs with Corticosteroids is Not Recommended: Routine PPI prophylaxis is not recommended with patients on short or long-term corticosteroids treatment. This is due to a lack of quality data showing PPI prophylaxis reduces the risk of GI bleeding or perforation in this patient population.
  • Routine PPI Prophylaxis among NSAID users is Not Recommended: Additionally, the new guideline recommended routine PPI prophylaxis is not recommended for all patients on non-steroidal anti-inflammatory drugs. The consideration for the use of PPIs among patients taking NSAIDs is recommended based on the risk assessment for the prevention of GI complications.
The use of PPIs is linked to several potential side effects, including an increased risk of certain gastrointestinal infections, acute interstitial nephritis, and possible bone fractures (with some uncertainty). They also raise the risk of hypomagnesemia. Prolonged PPI use is also linked to a slight rise in iron and vitamin B12 deficiency risk.
This guideline document concludes the rampant use of PPIs across various medical conditions and population groups, bringing out a concern about their improper usage. As a result, formulations of these guidelines may promote the prudent and judicious use of PPIs in clinical practice settings. Alternative treatment options should be considered, and young patients should be closely monitored when PPIs are deemed necessary. The goal should be to prioritize non-pharmacological interventions and reserve PPIs for cases where their benefits clearly outweigh potential risks in children.

Reference: Dutta, Amit Kumar et al. “Guidelines on optimizing the use of proton pump inhibitors: PPI stewardship.” Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology, 10.1007/s12664-023-01428-7. September 12 2023, doi:10.1007/s12664-023-01428-7

proton pump inhibitorsppippi in infantsppi safetyppi in childrendiscourage ppi in childrenppi in children below 1 yearindian society of gastroenterologyindian society of gastroenterology guidelinesafety of ppi in childrenppi and nsaids coprescription safetyppi and corticosteroids safetyppi and bleeding risk
Dr. Kamal Kant Kohli
Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

Show Full Article
Next Story

Editorial

How to Improve Adherence in Hypertensive Patients? Bridging the Gap with CONNECT Tool

How to Improve Adherence in Hypertensive Patients? Bridging the Gap with CONNECT Tool

Vestibular Migraine: Clinical Update and Role of Buccal Prochlorperazine

Vestibular Migraine: Clinical Update and Role of Buccal Prochlorperazine

U.S. FDA Drug Safety Alert: Warning Issued for Severe Itching After Stopping Long-Term Cetirizine or Levocetirizine Use

U.S. FDA Drug Safety Alert: Warning Issued for Severe Itching After Stopping Long-Term Cetirizine or...

Aspirin in Primary Prevention: Prudent Guideline-Based Approach

Aspirin in Primary Prevention: Prudent Guideline-Based Approach

Prediabetes and CKD: An Overlooked Interaction in Early Metabolic Disease

Prediabetes and CKD: An Overlooked Interaction in Early Metabolic Disease

View All

Journal Club Today

New Cancer Test May Identify Who Wont Respond to Chemotherapy: Study Suggests

New Cancer Test May Identify Who Won't Respond to Chemotherapy: Study Suggests

View All

Health News Today

Health Bulletin 24/June/2025

Health Bulletin 24/June/2025

View All
© 2022 All Rights Reserved.
Powered By: Hocalwire
X
We use cookies for analytics, advertising and to improve our site. You agree to our use of cookies by continuing to use our site. To know more, see our Cookie Policy and Cookie Settings.Ok