Prescription of antiacid, ant-H2 and PPI in the first three years of life in the Piedmont Region

Key words: Gastroesophageal reflux disease (GERD), Antiacid, Anti-H2, Prescription, Proton Pump Inhibitors (PPI)

Background - Despite the dissemination of guidelines and recommendations the treatment of gastroesophageal reflux (GER) in the paediatric population is continuously increasing. In Italy the phenomenon is still poorly documented.
Objective - Aim of this paper is to describe the occurrence and the frequency distribution of the prescription of antiacids, anti-H2 and PPI in the 0 and 36 months infant population in the Piedmont Region.
Materials and methods - All ATC A02 prescriptions archived in the regional pharmaceutical data system assigned to a 0 to 3 years child in the period 2011-2013 were recovered. All prescriptions were grouped into three main pharmacological categories: antiacids, anti- H2 and PPI. Overall prescription, age and year specific rates were calculated.
Results - A total of 18,523 prescriptions of approximately 60 treatments per thousand children were retrieved. The prescription rates were respectively in the three age 75.8 vs 12.7 and 10.5 prescriptions per thousand children in 2011; 68.5, 11.5 and 9.0 in 2012 and 61.7, 10.9 and 9.3 in 2013. Children aged 0-1 years were exposed to treatment 6/7 times more than those aged 1 to 2 and 2 to 3 years of age. The majority of these children (70% vs 53% and 61% in the three age groups) had only one prescription in the course of the year. The antiacid and anti-H2 were the most prescribed drugs, the observed trend in the studied period is slightly lowering.
Conclusions - One child out of 14 new-borns is being treated for GERD in the Piedmont Region. This high rate of prescriptions in the first year of life reinforces the already known: GER in infants is physiological and resolves spontaneously, for this reason its treatment is incongruous. To deal with the observed phenomenon multiple initiatives are needed, starting from the legislative down to the clinical level. It is also of utmost importance to consolidate a robust interregional surveillance system.