NOSOCOMIAL PNEUMONIA DURING STRESS-ULCER PROPHYLAXIS WITH CIMETIDINE AND SUCRALFATE

Background: Recent studies have questioned the use of histamine (H-2) receptor antagonist in stress ulcer prophylaxis because of an increase d incidence of noscomial pneumonia and subsequent death. Design: This prospective randomized study compared prophylaxis with cimetidine vs s ucralfate. Setting: Medical/surgical intensive care unit in Springfiel d, Mass. Patients: One hundred fourteen patients were enrolled. Interv entions: Cimetidine, administered as a primed continuous infusion usin g a 300-mg bolus followed by 31.5 mg/h, was compared with sucralfate, administered via nasogastric tube, at a dosage of 1 g every 6 hours su spended in 20 ml of sterile water. Main Outcome Measures: End points o f the study included nosocomial pneumonia, gastrointestinal hemorrhage , and death. Results: Fifty-six patients were randomized to receive ci metidine and their rate of pneumonia was 12.5%; upper gastrointestinal hemorrhage, 3.6%: and mortality, 33.9%. Fifty-eight patients were giv en sucralfare, and their rate of pneu- monia was 13.8%; upper gastroin testinal hemorrhage, 3.4%; and mortality, 37.9%. There were no signifi cant differences between these study end points. In patients who had p neumonia, 80% of isolates were aerobic gram-negative bacilli.Conclusio ns: These observations suggest that the rate of nosocomial pneumonia i s not increased in patients in the intensive care unit who receive pro phylaxis with cimetidine to prevent stress ulcer bleeding.