COMPARISON OF THE EFFECT OF INTERMITTENT ADMINISTRATION AND CONTINUOUS-INFUSION OF FAMOTIDINE ON GASTRIC PH IN CRITICALLY ILL PATIENTS - RESULTS OF A PROSPECTIVE, RANDOMIZED, CROSSOVER STUDY

Objectives: To compare the effects of intermittent intravenous adminis tration and continuous intravenous infusion of famotidine on gastric p H in critically ill patients, Design: A prospective, randomized, cross over study of continuous infusion and bolus administration of famotidi ne in critically ill patients, Setting: A 14-bed medical intensive car e unit (ICU) of a 500-bed county hospital, Patients: Medical ICU patie nts requiring stress ulcer prophylaxis, Interventions: Patients were r andomized to receive an equivalent dose of famotidine by continuous in fusion or intravenous bolus for 24 hrs, and then were crossed over to the other arm of the study, Measurements and Main Results: Critically ill patients who met the inclusion criteria were randomly assigned to receive famotidine 20 mg iv over 10 mins, every 12 hrs or a continuous infusion of 1.7 mg/hr for 24 hrs, After a 16-hr washout period, patie nts crossed over to the other arm of the study. Gastric pH was monitor ed continuously for 24 hrs. A total of 710 gastric pH measurements wer e obtained for each phase of the study, The mean area under the ps-tim e curve for a 24-hr period was higher for continuous infusion than bol us administration (p = .05), Continuous infusion of famotidine maintai ned a gastric pH of greater than or equal to 4 over a longer time peri od than bolus administration (20.8 hrs vs, 12.6 hrs, respectively; p < .01), Onset of therapeutic gastric pH for continuous infusion was sli ghtly delayed as compared with bolus administration, Conclusions: Cont inuous infusion of famotidine is more effective than an equivalent dos e given by intermittent bolus in maintaining the appropriate gastric p H necessary for prevention of stress ulceration, Delayed onset of effe ct may warrant a priming dose when famotidine is given by continuous i nfusion.