Klin Farmakol Farm. 2026;40(2):116-123 | DOI: 10.36290/far.2026.009

Proton pump inhibitors: rational prescribing and long-term safety in children

Jana Tomanová¹, Petra Rozsívalová^{2, 3}, Rita Halašová¹, Josef Malý³, Jan Melek¹

¹ Dětská klinika, Fakultní nemocnice Hradec Králové, Lékařská fakulta v Hradci Králové, Univerzita Karlova

² Oddělení klinické farmacie, Nemocniční lékárna, Fakultní nemocnice Hradec Králové

³ Katedra sociální a klinické farmacie, Farmaceutická fakulta v Hradci Králové, Univerzita Karlova

Proton pump inhibitors (PPIs) are among the most commonly prescribed drugs in paediatrics, with their prescription rates having significantly increased in recent years. Although effective for indications such as gastroesophageal reflux disease, peptic ulcers, or eosinophilic esophagitis, concerns remain regarding their safety, dosing, and frequent off-label use, especially in infants and newborns. This article provides a comprehensive overview of the pharmacological properties of PPIs in the pediatric population, focusing on the specifics of pharmacokinetics and pharmacodynamics in different age groups. It considers the influence of CYP2C19 genetic polymorphism on metabolism and clinical response. Furthermore, it summarizes current recommendations for indications, dosing, and available drug forms. It also mentions the appropriateness of taking into account the age of the pediatric patient and the associated changes in the rate of metabolic and elimination processes. Special attention is paid to long-term safety and the risks associated with treatment, such as infections, fractures, or allergies. Among the most common prescribing errors are the unindicated use of PPIs in the treatment of physiological reflux, excessively prolonged administration of the drug, and the use of an inappropriate dosage form. The aim is to promote the rational prescription of PPIs, optimize treatment, and minimize risks for paediatric patients.

Keywords: proton pump inhibitors, paediatrics, safety, adverse effects, rational prescribing.

Received: January 20, 2026; Revised: February 26, 2026; Accepted: February 26, 2026; Published: July 1, 2026  Show citation