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Nosocomial pneumonia during stress ulcer prophylaxis with cimetidine and sucralfate
1Department of Medicine and Surgery, Baystate Medical Center, Springfield, Mass.
Background:
Recent studies have questioned the use of histamine (H2) receptor antagonist in stress ulcer prophylaxis because of an increased incidence of nosocomial pneumonia and subsequent death.
Design:
This prospective randomized study compared prophylaxis with cimetidine vs sucralfate.
Setting:
Medical/surgical intensive care unit in Springfield, Mass.
Patients:
One hundred fourteen patients were enrolled.
Interventions:
Cimetidine, administered as a primed continuous infusion using a 300-mg bolus followed by 37.5 mg/h, was compared with sucralfate, administered via nasogastric tube, at a dosage of 1 g every 6 hours suspended in 20 mL of sterile water.
Main Outcome Measures:
End points of the study included nosocomial pneumonia, gastrointestinal hemorrhage, and death.
Results:
Fifty-six patients were randomized to receive cimetidine and their rate of pneumonia was 12.5%; upper gastrointestinal hemorrhage, 3.6%; and mortality, 33.9%. Fifty-eight patients were given sucralfate, and their rate of pneumonia was 13.8%; upper gastrointestinal hemorrhage, 3.4%; and mortality, 37.9%. There were no significant differences between these study end points. In patients who had pneumonia, 80% of isolates were aerobic gram-negative bacilli.
Conclusions:
These observations suggest that the rate of nosocomial pneumonia is not increased in patients in the intensive care unit who receive prophylaxis with cimetidine to prevent stress ulcer bleeding.