Nosocomial pneumonia during stress ulcer prophylaxis with cimetidine and sucralfate

Abstract

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.