Saturday, April 24, 2010

PPIs (Prevacid, Prilosec) in Pediatrics

As a pharmacist at a compounding pharmacy, I see proton pump inhibitors (PPIs), most commonly Prevacid and Prilosec, prescribed to pediatric patients as young as 7 days old. Based on current evidence, I urge parents to be vigilant not to give these drugs to their babies! I have listed several reasons, including long term side effects below.

1. Current guidelines state that safety and efficacy (how well a medication works) have not been established in infants.

2. The following serious side effects in children after long term use 2 to 11 years have been reported:
-Increasing evidence suggests that acid suppression is associated with increased rates of pneumonia and gastrenteritis in children, and candidemia and necrotizing enterocolitis in preterm infants.
-PPI's have been shown to alter the gastric and intestinal flora.
-Animal studies suggest that acid suppression may predispose to the development of food allergies.
-Decrease in absorption of iron and B12
-Other side effects of PPIs include headache, diahhrea, constipation, nausea, hyperplasia and acute renal failure.

-Lansoprazole: No more effective than placebo in patients 1 month to less than 1 year of age with symptomatic GERD in a multi-center, double-blind, placebo controlled study (Micromedex)
-Omeprazole: Used for the treatment of erosive esophagitis and GERD, or the maintenance of healing of erosive esophagitis has not been found safe or effective in pediatric patients less than 1 year of age. The safety and efficacy for other pediatric uses have not been established (Prod Info PRILOSEC(R) oral delayed-release capsules, suspension, 2008)

4. A study on PPIs in Pediatrics:
-Therapy with gastric acidity inhibitors increases the risk of acute gastroenteritis and community-acquired pneumonia in children. Canani RB, Cirillo P, Roggero P, Romano C, Malamisura B, Terrin G, Passariello A, Manguso F, Morelli L, Guarino A; Working Group on Intestinal Infections of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition
-OBJECTIVE: A prolonged gastric acid (GA) inhibitor-induced hypochlorhydria has been suggested as a risk factor for severe gastrointestinal infections. Recently, an increased risk of community-acquired pneumonia associated with GA inhibitor treatment has been reported in a large cohort of adult patients. These findings are particularly relevant to pediatricians today because so many children receive some sort of GA-blocking agent to treat GERD.
It is a multicenter, prospective study. The study was performed by expert pediatric gastroenterologists from 4 pediatric gastroenterology centers
-Inclusion criteria: Children (aged 4-36 months) consecutively referred for common GERD-related symptoms (for example, regurgitation and vomiting, feeding problems, effortless vomiting, choking)
-RESULTS: Total 186 subjects: 95 healthy controls and 91 GA-inhibitor users (47 on ranitidine and 44 on omeprazole). The 2 groups were comparable for age, gender, weight, length, and incidence of acute gastroenteritis and pneumonia in the 4 months before enrollment. Rate of subjects presenting with acute gastroenteritis and community-acquired pneumonia was significantly increased in patients treated with GA inhibitors compared with healthy controls during the 4-month follow-up period. No differences were observed between H2 blocker and PPI users in acute gastroenteritis and pneumonia incidence in the previous 4 months and during the follow-up period. On the contrary, in healthy controls, the incidence of acute gastroenteritis and pneumonia remained stable.

5. Current adult guidelines suggest these medications be used on a short term basis only. If you do decide to put your child on a PPI, please consider doing it short term only (less than 28 days).

If your child is being put on a PPI because he is not putting on weight/having violent spit ups, etc., consider that PPIs may cause malabsorbtion of nutrients by creating an alkaline environment in the stomach and small intestine.

Coming soon... Alternates to PPIs and natural assistance with GERD.

Note: This is not to be used as medical advice, please see you healthcare professional when treating your child for any condition.

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