Use of proton pump inhibitors in children in a tertiary hospital in Belgium

Proton pump inhibitors (PPIs) are frequently prescribed in paediatrics, yet increasing evidence suggests that their use is often inconsistent with clinical guidelines and may be associated with significant safety concerns. We conducted a retrospective study using the dispensing database of a tertiary care hospital in Brussels, Belgium. All PPI dispensed to children under 18 years of age between January 1, 2022 and January 31, 2024 were extracted. Subsequent administrations of the PPIs were linked with clinical data from electronic medical files. Appropriateness of use was assessed using regulatory labelling and the Dutch paediatric pharmacotherapy reference, Kinderformularium. Data were stratified by age category. The main outcomes included indication, dose appropriateness, treatment duration, and deprescribing practices. A total of 658 children received at least one PPI. PPIs were used across all paediatric age groups (0-18 years), most commonly prescribed by paediatricians (59.5%) and emergency physicians (12.9%). The median duration of treatment was 3 days (IQR: 2-7), being similar across age groups. Only 7.6% of children received PPIs for an officially approved indication. The majority (94.4%) of prescriptions were for off-label indications or lacked documentation of any indication. Dosing appropriateness varied by age and indication. Among children receiving PPIs for on-label indications (n = 50), less than half were prescribed a correct dose. In the off-label group (n = 608), dosing was frequently excessive, especially in younger age groups. As age increased, dose appropriateness improved. When PPIs were discontinued, either during hospitalization or at discharge, cessation was abrupt, with no evidence of tapering strategies. Three percent of children were prescribed a continuation of PPI treatment after discharge.Conclusion: These findings highlight significant gaps in guideline adherence and underscore the need for improved prescribing and deprescribing practices in paediatric care. What is Known:center dot Proton pump inhibitors (PPIs) are widely used in children, often for off-label indications.center dot Appropriate prescribing and deprescribing practices in paediatrics remain poorly studied.What is New:center dot This study quantifies off-label use, inappropriate dosing, and unstructured deprescribing of PPIs in hospitalized children.center dot Findings highlight the urgent need for paediatric-specific evidence-based guidelines on PPI use and deprescribing.