PPI prescriptions reach a new record high: We have reported several times (e.g. a-t 2009; 40: 90 and a-t 2006; 37: 103-4) on the steady increase in prescriptions of proton pump inhibitors (PPIs) such as omeprazole (ANTRA, generics). 2009 saw a new record high, with nearly two (1.973) billion defined daily doses paid for by the statutory health-insurance system. The number of PPI prescriptions has been rising consistently by 15% to 20% per annum for years and has increased six-fold since 2000 (MÖSSNER, J. in SCHWABE, U., PAFFRATH, D. [ed.]: "Arzneiverordnungs-Report 2010" ["2010 Drug Prescriptions Report"], Springer, Heidelberg 2010, page 681ff). This rise can in no way be explained as a rise in typical illnesses with a confirmed indication for PPIs: although it is true that erosive gastroesophageal reflux diseases are becoming more common in Western industrialised nations, peptic and intestinal ulcers are on the decrease. In addition, prescriptions of H2-blockers or antacids have not fallen by nearly the same degree as prescriptions of PPIs have increased. The reason is an uncritical extension of the indications for PPIs. This applies to non-erosive reflux diseases and to simple reflux problems, from which up to 20% of adults suffer according to some reports, which manufacturers also gladly pass on. If non-medical strategies are not sufficient, PPIs should, in these cases, be taken for only a limited amount of time, in the lowest possible dose and tailored to need. However, over-prescribing also occurs in functional dyspepsia. The effectiveness of PPIs in this (off-label) indication is low and has been demonstrated only in short-term use. PPIs are indicated, and are the drugs of choice, for the prevention of ulcers in at-risk patients taking non-steroidal anti-inflammatory drugs (NSAIDs). Often, however, particularly in in-patient settings, they are prescribed automatically on initiation of NSAID treatment or for the prevention of stress ulcers. The risk factors for NSAID complications include particularly previous gastro-intestinal ulcers or bleeding but also age over 65 years and comedication with corticosteroids, anticoagulants or acetylsalicylic acid. Whether just one of the latter factors is sufficient to establish the indication is controversial. Overall, PPIs are well-tolerated but observational studies in recent years show clear evidence of an increased osteoporosis and fracture risk (a-t 2007; 38: 49-50 and 2010; 41: 66). The risk of community-acquired clostridia infections and pneumonia also appears to be rising (a-t 2006; 37: 16 and 2008; 39: 95-7). Furthermore, case reports of symptomatic hypomagnesaemia (a-t 2010; 41: 98) and interstitial nephritis are on the increase. Moreover, PPIs are suspected of encouraging their own long-term use by triggering withdrawal symptoms (a-t 2009; 40: 90). The indication for proton pump inhibitors should be established strictly. The need for long-term ingestion should be reviewed at regular intervals. - Ed.