Prophylactic Use Of Ranitidine in Pediatric Settings: Experts Opine

Despite the effectiveness
of PPIs, they have delayed onset of action, thus limiting their on-demand use.
(3) Amidst such practical challenges,
the use of H2RAs such as Ranitidine have retained their clinical applicability for acid suppression
in pediatric settings because of their efficacy and better safety profile.
Ranitidine is effective in managing stress-induced gastric lesions in
critically ill pediatric patients, reducing gastric fluid volume when used as
preoperative prophylaxis, and preventing nocturnal acid reflux among pediatric
patients. (1)

A gap in scientific
consensus on the prophylactic application of Ranitidine in pediatric clinical
settings led to the recommendations convened by thirteen Indian pediatricians
and pediatric gastroenterologists based on consolidation of evidence and
clinical experience. (1)

The review, which has
been published in the International
Journal of Contemporary Pediatrics, recommended the prophylactic use of
Ranitidine in the following conditions: (1)

Ranitidine is effective in managing stress-induced gastric lesions
in critically ill pediatric patients in ICU.Ranitidine reduces gastric fluid volume when used as pre-operative
prophylaxis.Ranitidine effectively prevents acid reflux at night

Ranitidine as Pre-Operative Prophylaxis: Regarding the prophylactic
potential of the drug, all pediatricians and pediatric gastroenterologists
unanimously agreed that the pre-operative use of Ranitidine might be considered
to reduce the risk of aspiration in pediatric patients undergoing operative
procedures. (1)

Speaking to Medical Dialogues, Dr. Bhaswati Acharyya, Consultant Pediatric Gastroenterologist
& Hepatologist, AMRI Hospital, Kolkata, and one of the panelists in
the review board said, “Gastric volume
reduction is required to keep the airway passages and lungs clear from
aspirating gastric contents and to avoid vomiting during anesthesia.”

Comparing the net benefit of
Ranitidine and PPI for preoperative gastric volume reduction, Dr. Acharyya
said, “Ranitidine might be better in
reducing total gastric secretion compared to PPIs. Ranitidine can be
administered pre-operatively to avoid acidulated injuries during abdominal
surgery.”.

Ranitidine for Preventing Nocturnal Reflux:
The recommendations noted the
effectiveness of Ranitidine in preventing acid reflux at night. It further
highlighted that the nocturnal use of Ranitidine is proven more effective than
PPIs in preventing acid reflux at night. (1)

Elaborating on the above statements, Dr.
Abhay K Shah, Senior Practicing Pediatrician and Infectious
Diseases Consultant in Ahmedabad, Gujarat, said, “Nocturnal reflux is commonly encountered
in the pediatric population, more so in obese patients.”

Regarding the comparative efficacy
of Ranitidine and PPI for preventing nocturnal acid reflux, Dr. Shah said, “The rapid onset of action and prompt relief
ensuring good sleep in nocturnal reflux cases are some of the advantages of
Ranitidine over PPI in pediatric patients.”

Ranitidine in Stress-Induced Mucosal Damage: Additionally, the review
highlighted the clinical applicability of Ranitidine in managing stress-induced
gastric lesions in critically ill pediatric patients admitted to the ICU.
(1)

Pediatric Gastroenterologist &
Hepatologist, Fortis Hospitals (Fortis
Gurgaon and Noida),
Dr. Deepak Goyal, said-

“Stress-induced mucosal damage is common among pediatric intensive-care
patients, those with acute or chronic stress, prolonged illnesses, infections,
acute inflammatory states, major burns, and respiratory disorders. The lack of protective factors in the mucosal
lining leads to a high risk for mucosal injury in children.”

Describing
the rationale for Ranitidine use in mucosal injuries and comparing its efficacy
with PPIs, Dr. Goyal said, “The rapid
onset of action, optimum efficacy, and well-tolerated safety profile favour use
of Ranitidine over PPIs. Also, Ranitidine action ensures it doesn’t
completely suppress stomach acid, since the body needs a small quantity of
stomach acid to function as a natural defense mechanism. Whereas PPIs suppress the acid to a greater
extent in comparison to Ranitidine, which could have untoward repercussions for
their use from the gastric first line defense standpoint.”

Reference

1. Pai
UA, Kesavelu D, Shah AK, Manglik AK, Wadhwa A, Acharya B, et al.
Ranitidine use in pediatrics: current evidence-based review and
recommendations. Int J Contemp Pediatr 2022;9:987-97.

2. Shin JM, Sachs G.
Pharmacology of proton pump inhibitors. Curr Gastroenterol Rep. 2008
Dec;10(6):528-34. 

3. Herszényi L,
Bakucz T, Barabás L, Tulassay Z. Pharmacological Approach to Gastric Acid
Suppression: Past, Present, and Future. Dig Dis. 2020;38(2):104-111.