Nosocomial pneumonia during stress ulcer prophylaxis with cimetidine and sucralfate
P. Ryan, J. Dawson, D. Teres, G. Celoria and F. Navab
Department 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.
