Deprescribing proton pump inhibitors: Addressing prolonged and unnecessary use in paediatric hospitalised children

Abstract

Background: Proton pump inhibitors (PPIs) are approved for shorth-term (≤ 12 weeks) use in children older than one month. Long-term PPI therapy has been associated with increased risk of gastrointestinal and respiratory infections, fractures and micronutrient deficiencies. This study will be the first to describe paediatric PPI use in hospitalised paediatric patients in South Africa in relation to Hospital Level Paediatric Standard Treatment Guidelines (STG)-recommendations of PPI therapy. Methods: A retrospective cross-sectional study was conducted across two tertiary public hospitals in South Africa (01 February 2023–31 January 2024). Data from medical records of paediatric hospitalised patients (< 18 years) who received a PPI prescription within the study period were evaluated. Data analysed included demographic data, in-hospital and discharge PPI prescription particulars. Descriptive statistics were used to present the analysed data. Results: Among 400 patients, only 28% of prescriptions aligned with STG-recommended indications, while 48% of prescriptions were prescribed for non-recommended indications. The median duration of PPI therapy was 31 days and only 7% of prescriptions complied with STG-recommended durations. Long-term use (> 12 weeks) occurred in 17.5% of patients. Deprescribing strategies of PPI prescriptions was employed in 23.8% of cases, predominantly intravenous (IV)-to-oral de-escalation. Conclusion: The findings highlight STG prescribing deviations and infrequent attempts of PPI deprescribing. Structured PPI prescription review processes, clear STG recommendations and proactive deprescribing strategies are required to promote rational PPI use.