Omeprazole (Paediatric — GORD/Peptic)

How it works

It irreversibly inhibits the gastric H+/K+-ATPase (proton pump) in parietal cells, markedly reducing gastric acid secretion.

Prescribing in practice

• The most important paediatric point is that PPIs should be used for a defined indication and reviewed regularly rather than continued indefinitely, as reflux is often physiological in infants and prolonged acid suppression is associated with increased gastrointestinal and respiratory infections.
• It may mask symptoms of more serious upper-gastrointestinal disease and can interact with drugs requiring gastric acidity for absorption or metabolised via CYP enzymes.
• It is given once daily before food, with dispersible formulations available; doses are weight-based and should be confirmed against a children's formulary.

Monitoring

Monitor symptom response and the continued need for treatment at review, with attention to growth and any alarm features.

Counselling the patient

• Give before a meal, and disperse the tablet or use granules as directed for young children.
• The aim is to use the lowest effective course, with regular review of whether it is still needed.
• Report persistent vomiting, poor feeding, weight loss or blood in vomit or stool.

Evidence & guidelines

NICE guidance on gastro-oesophageal reflux in children supports time-limited PPI use for reflux oesophagitis and recommends regular review.