Widespread use of gastric acid inhibitors in infants: Are they needed? Are they safe?

Table 2 Outline of the proposed side effects associated with proton pump inhibitors use, and the evidence supporting the association

Potential side effects	Level of evidence showing an association with PPI use
Acute Interstitial Nephritis	Level III
Bacterial overgrowth in the stomach, small and large intestine	Murine models
Bacterial enteric infections Causative agents: Clostridium difficileSalmonella species Campylobacter species	Level I
Pneumonia (Community-acquired)	Level I
Necrotizing enterocolitis	Level III1
Blood stream infections, including candidemia	Level III1
Allergic sensitization in adults and in children with in utero exposure	Level III Study and Murine Models
Parietal and Enterochromaffin-like cell hyperplasia	Level II
Fundic gland polyps	Level III
Vitamin B12 deficiency	Level III
Fractures (osteoporotic and non-osteoporotic)	Level III
Hypomagnesemia	Level IV and one level III study
Reduced Antiplatelet effect of Clopidogrel	Level II
Adverse Cardiovascular outcomes due to Clopidogrel interactions	Level III2

¹Only single reports showing an association with acid inhibition induced by H2RA treatment;

²RCTs (level II) not shown an increase risk of adverse outcomes.