PPI Misuse in Bangladesh: Confronting a Silent Epidemic Through Deprescribing and Regulatory Reform-A Policy Perspective.

BACKGROUND AND AIMS: Proton pump inhibitors (PPIs) are subject to rampant global misuse, posing a significant public health challenge. This issue is particularly acute in low- and middle-income countries like Bangladesh, where preliminary data indicate alarmingly high rates of inappropriate prescribing, driven by systemic factors within the healthcare environment. The objective of this study is to critically analyze the systemic drivers, multifaceted consequences, and potential solutions for the widespread misuse of PPIs in Bangladesh, arguing that it constitutes an urgent, overlooked public health issue.

METHODS

We conducted a narrative review of existing literature, local health data, and international pharmacovigilance reports to synthesize current evidence regarding PPI prescribing patterns, adverse effects, and regulatory challenges.

RESULTS

Key drivers of misuse in Bangladesh include a lack of diagnostic justification, non-guideline prophylaxis, unregulated over-the-counter (OTC) sales, clinical inertia against deprescribing, and aggressive pharmaceutical marketing. The consequences are profound, encompassing severe long-term health risks (e.g., osteoporotic fractures, chronic kidney disease, enteric infections, and micronutrient deficiencies) and a substantial economic burden on a population reliant on out-of-pocket payments, undermining progress towards universal health coverage.

CONCLUSION

Addressing PPI misuse is an urgent public health priority. A multi-pronged strategy is required, incorporating the development of national prescribing guidelines, robust education for clinicians and the public, strengthened regulatory oversight, and a cultural shift towards judicious medication use. Tackling this challenge is essential for safeguarding population health and ensuring a sustainable healthcare system in Bangladesh.