Non-guideline-recommended prescribing of proton pump inhibitors: implications for the future and reducing over usage: Re: Mares-Garcia E, Palazon-Bru A, Martinez-Martin A, et al. Non-guideline-recommended prescribing of proton pump inhibitors in the general population.

Drs Godman and Fadare review the paper by Mares-Garcia and colleagues in Spain regarding the extent of non-guideline recommended prescribing (NGRP) of proton pump inhibitors (PPIs) in ambulatory care. NGRP of PPIs is an increasing public health concern given the implications of overuse of PPIs on infection rates, osteoporosis and chronic kidney disease as well as increasing polypharmacy rates. Costs are less of an issue especially where there are low prices for generic PPIs; the main focus is on improving the quality of PPI prescribing. Encouragingly, Mares-Garcia and colleagues identified key factors associated with NGRP, providing direction to others.