Cimetidine vs antacid in prophylaxis for stress ulceration
J. A. Weigelt, C. M. Aurbakken, B. L. Gewertz and W. H. Snyder 3rd
Seven-seven critically ill patients were prospectively randomized into four
groups to compare antacids and various doses of cimetidine in the
neutralization of gastric acid for preventing complications of stress
ulcers. Gastric pH was monitored hourly, basing the efficacy of
neutralization on preselected pH values for each study group. Cimetidine
provided adequate neutralization in 14 (23%) of 61 patients. Gastric acid
in all 16 patients treated with antacids was adequately neutralized. Stress
bleeding occurred in three (5%) patients treated with cimetidine and in no
patient treated with antacids. Reversible thrombocytopenia developed in six
(26%) of 23 patients treated with 2,400 mg/day of cimetidine. Hourly
monitoring of gastric pH is a mandatory component in the prevention of
stress bleeding. Antacid is the preferred agent for gastric acid
neutralization because it is more effective, safer, and less expensive.
