Gastroesophageal reflux disease in children: What’s new right now?

Table 4 Summarizes the drugs used in infants and children with gastroesophageal reflux disease[1-5] (for guidance only, prior to use please refer to local formulary and guidelines for accuracy and appropriate doses)

Medication	Dose	Adverse effect	Approved age (FDA indicated)
PPI1
Omeprazole	1-4 mg/kg/d od	Diarrhea, abdominal pain, flatulence, headache, enteric infection, respiratory infection, rebound hypersecretion	> 1 yr old
Lansoprazole	0.7-2 mg/kg/d od	1Esomeprazole: Tarry stool, darkened urine	> 1 yr old
Esomeprazole	3-5 kg: 2.5 mg od	1Rabeprazole: Light-colored stool	> 1 mo old
	> 5-7 kg: 5 mg od
	> 7.5 kg, < 20 kg: 10 mg od
	20 kg: 20 mg od
Pantoprazole	1-2 mg/kg/d od		> 5 yr old
Rabeprazole	0.5-1.0 mg/kg/d od		> 1 yr old
Pro-motility
Metoclopramide	0.4-0.9 mg/kg/d tid	Extrapyramidal side effect (1%), diarrhea, drowsiness	> 1 yr old
Domperidone	0.8-0.9 mg/kg/d tid	Dry mouth, QT prolongation (rare) Abdominal pain, diarrhea, (rare) HPS in infants, QT prolongation (rare)	> 12 yr old
Erythromycin	5 mg/kg/dose qid	Dizziness, diarrhea, dry mouth	All ages
Baclofen	0.5 mg/kg/d tid		All ages
Esophageal mucosal protection
Alginate antacid		Flatulence, diarrhea, nausea and vomiting	Younger than 12 yr of age is not generally recommended
Magnesium alginate plus simethicone	Infant: 1-2 mL/kg/dose after feeding
Sodium alginate (225.00 mg sodium alginate, 87.25 mg magnesium alginate per sachet)	Child: 2.5-5.0 mL oral tid after meal
Sucralfate (sucrose, polyaluminium hydroxide)	40-80 mg/kg/d qid	Constipation, aluminum toxicity in long-term use	In adult
Esoxx (sodium hyaluronate, sodium chondroitin sulfate, poloxamer 407, povidone K30, xylitol, potassium sorbate, sodium benzoate, red grape aroma, purified water) (10 mL/sachet)	1-2 sachet/d after main meal and bedtime	No serious adverse effect because of the poor absorption, however, no data of long-term adverse effect	In Italy, it is approval for adolescents age > 12 yr old
Probiotics
Lactobacillus reuteri DSM 17938	> 1 × 108 colony-forming units/d od	None	All ages

¹Dose depend on metabolizer via cytochrome P2C19. FDA; od; bid; tid; qid.

PPI: Proton pump inhibitor.