Quality statement 8: Domperidone, metoclopramide and erythromycin

Quality statement

Infants, children and young people are not prescribed domperidone, metoclopramide or erythromycin to manage gastro‑oesophageal reflux (GOR) or gastro‑oesophageal reflux disease (GORD) without specialist paediatric advice.

Rationale

Prokinetics such as domperidone and metoclopramide are associated with a range of risks such as neurological and cardiac adverse events. Domperidone, metoclopramide and erythromycin (which is used in GOR and GORD for its prokinetic properties) should only be prescribed for infants, children and young people if there is an agreement for its use by a specialist paediatric healthcare professional.

Quality measures

Structure

Evidence of local arrangements to ensure that infants, children and young people are not prescribed domperidone, metoclopramide or erythromycin to manage GOR or GORD without specialist paediatric advice.

Data source: Local data collection.

Process

Proportion of infants, children and young people prescribed domperidone, metoclopramide or erythromycin to manage GOR or GORD on the basis of specialist paediatric advice.

Numerator – number in the denominator who were prescribed domperidone, metoclopramide or erythromycin on the basis of specialist paediatric advice.

Denominator – number of infants, children and young people prescribed domperidone, metoclopramide or erythromycin to manage GOR or GORD.

Data source: Local data collection.

Outcome

Domperidone, metoclopramide and erythromycin prescribing among infants, children and young people.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (secondary care, community care providers, GP practices) ensure that there are practice arrangements and written clinical protocols to ensure that infants, children and young people are not prescribed domperidone, metoclopramide or erythromycin to manage GOR or GORD without specialist paediatric advice.

Healthcare professionals (midwives, paediatric nurses or GPs) do not prescribe domperidone, metoclopramide or erythromycin to manage GOR or GORD in infants, children and young people without specialist paediatric advice.

Commissioners (clinical commissioning groups and NHS England) ensure that services they commission do not prescribe domperidone, metoclopramide or erythromycin to manage GOR or GORD in infants, children and young people without specialist paediatric advice.

What the quality statement means for infants, children and young people

Infants, children and young people are not prescribed medicines called domperidone, metoclopramide or erythromycin to manage reflux unless a specialist advises it.

Source guidance

Definitions of terms used in this quality statement

Specialist

Specialist refers to a paediatrician with the skills, experience and competency necessary to deal with the particular clinical concern that has been identified by the referring healthcare professional. In this guideline this is most likely to be a consultant general paediatrician. Depending on the clinical circumstances, 'specialist' may also refer to a paediatric surgeon, paediatric gastroenterologist or a doctor with the equivalent skills and competency.

[Gastro-oesophageal reflux disease in children and young people (2015) NICE guideline NG1, definitions section]