Proton pump inhibitors for infants in three Scandinavian countries increased from 2007 to 2020 despite international recommendations

Abstract

Aim: There is weak evidence that proton pump inhibitors (PPIs) alleviate non-specific complaints often attributed to gastroesophageal reflux in infancy and international guidelines do not recommend their use. We studied PPIs dispensed for infants in three Nordic countries. Methods: This was an observational population-based study of infants living in Norway, Sweden and Denmark in 2007–2020. We used nationwide pharmaceutical registers to study dispensed PPIs. The data provided a total of 3.3 million observed years on about 240 000 annual births. Results: The overall use of PPIs in infancy showed a marked increase in all three countries from 2007 to 2020. In 2020, PPI dispensing was 46.4, 23.4 and 18.9 per 1000 per year in infants aged 0–11 months in Denmark, Norway and Sweden. These were increases of 357%, 585% and 556% respectively. Although the rate was highest in Denmark, it had decreased by 42% in the last 3 years of the study. Conclusion: Despite international recommendations against routine PPI prescribing in infancy, dispensed PPIs increased more than fourfold on average in three Nordic countries from 2007 to 2020. The reason for this notable increase could not be established from the data, but the large variations over time, and between the countries, probably indicated unwarranted use.