In their article, Fabian et al1 addressed a clinically significant topic: the influence of different regimens of stress ulcer prophylaxis on the frequency of pneumonia in patients in intensive care units. They clearly showed that the administration of sucralfate did not result in a lower frequency of pneumonia compared with therapeutic regimens of cimetidine hydrochloride bolus and continuous infusion of cimetidine and, therefore, concluded that neither sucralfate nor cimetidine predisposes patients to pneumonia. Unfortunately, the authors did not realize that the study population is insufficient to test the hypothesis if histamine2 (H2)-antagonists increase the risk of pneumonia. Instead, the results of the present study strengthen our hypothesis about the stomach as a potential source of pulmonary infections in patients receiving long-term mechanical ventilation.
If the authors had performed a detailed literature search, they would have detected an article2 describing those factors resulting in an increase in the incidence of pneumonia
Tryba M. Pneumonia due to Stress Ulcer Prophylaxis With Cimetidine: A Necessary Consequence?. Arch Surg. 1993;128(9):1078-1079. doi:10.1001/archsurg.1993.01420210142024