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December 1993

Nosocomial Pneumonia During Stress Ulcer Prophylaxis With Cimetidine and Sucralfate

Author Affiliations

From the Department of Medicine and Surgery, Baystate Medical Center, Springfield, Mass (Drs Ryan, Dawson, Teres, Celoria, and Navab), and Tufts University School of Medicine, Boston, Mass (Drs Dawson, Teres, and Navab).

Arch Surg. 1993;128(12):1353-1357. doi:10.1001/archsurg.1993.01420240061011

Background:  Recent studies have questioned the use of histamine (H2) receptor antagonist in stress ulcer prophylaxis because of an increased incidence of noscomial 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%. Fiftyeight 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.(Arch Surg. 1993;128:1353-1357)