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Use of anti-reflux medications in infants under 1 year of age: a retrospective drug utilization study using national prescription reimbursement data

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An Editorial to this article was published on 05 November 2020

Abstract

Non-specific symptoms such as irritability, vomiting, and back arching during the infant period are often attributed to gastroesophageal reflux. While numerous studies have shown no significant benefit to the use of acid suppressant medications in this population, these medications are frequently prescribed in response to these symptoms. Our goals were to understand how often children were being prescribed this medication. To do this, data was extracted from a national database for reimbursement of prescribed medications through the General Medical Services scheme (GMS). Infants aged less than 1 year and eligible for reimbursement under GMS were included for analysis. A total of 450 infants per 10,000 eligible population received an anti-reflux preparation from the following drug classes (H2 antagonists, proton pump inhibitors, or alginate preparations) in 2018. This is compared with that in 2009 where only 137 per 10,000 eligible infants received these medications. This increase was predominantly attributable to an increase in ranitidine prescriptions.

Conclusion: Despite a change in clinical guidelines, anti-reflux preparations are increasingly being prescribed to infants aged less than 1 year. The reasons behind the increase in prescriptions containing these medications cannot be ascertained from this data. This may suggest a proportion of these prescriptions may be unwarranted in this population.

What is Known:

• The prescription of PPIs in infants has increased in a number of countries.

• Use of anti-reflux medications has a very poor evidence base in infancy.

What is New:

• This data focuses only on an infant age group in a “well” cohort.

• Ranitidine may contribute to increased acid-suppressant use in infancy.

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Abbreviations

PPI:

Proton pump inhibitor

H2RAs:

Histamine type 2 receptor antagonists

GORD:

Gastroesophageal reflux disease

CMPI:

Cow’s milk protein intolerance

CSO:

Central Statistics Office

GMS:

General Medical Services Scheme

HSE:

Health Service Executive

PCRS:

Primary care reimbursement service

ESPHAGN:

European Society for Gastroenterology, Hepatology and Nutrition

NASPHAGN:

North American Society for Gastroenterology, Hepatology and Nutrition

NICE:

National Institute of Clinical Excellence

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Acknowledgments

The authors thank David Stratton and Ivan McConkey, the Health Service Executive, and the Primary Care Reimbursement Service.

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Authors and Affiliations

  1. Emergency Department, Children’s Hospital Ireland, Temple Street, Dublin 1, Ireland

    Daniel O’Reilly & Patrick Fitzpatrick

  2. Department of Public Health South East, HSE, Kilkenny, Ireland

    Robert Conway

  3. Health Protection Surveillance Centre, Dublin, Ireland

    Lois O’Connor

Authors
  1. Daniel O’Reilly
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  2. Robert Conway
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  3. Lois O’Connor
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  4. Patrick Fitzpatrick
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Contributions

DOR: Generated hypothesis, designed study, drafted manuscript and approved final manuscript RC: Designed study, statistical analysis, drafted manuscript and approved final manuscript LOC: Refined study design, statistical analysis, refined manuscript and approved final manuscript PF: Generated hypothesis, refined manuscript and approved final manuscript.

Corresponding author

Correspondence to Daniel O’Reilly.

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The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any experiments with human participants or animals performed by any of the authors. It was performed retrospectively and using data which was already anonymized.

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Communicated by Peter de Winter

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O’Reilly, D., Conway, R., O’Connor, L. et al. Use of anti-reflux medications in infants under 1 year of age: a retrospective drug utilization study using national prescription reimbursement data. Eur J Pediatr 179, 1963–1967 (2020). https://doi.org/10.1007/s00431-020-03837-8

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  • DOI: https://doi.org/10.1007/s00431-020-03837-8

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