COMPARISON OF OMEPRAZOLE AND RANITIDINE FOR STRESS-ULCER PROPHYLAXIS

Stress ulcer prophylaxis protects against clinically important gastroi ntestinal bleeding and has gained widespread use. This study compares the efficacy of omeprazole to ranitidine for this indication. This was a prospective, randomized clinical trial. Sixty-seven high-risk patie nts were randomized to receive either ranitidine 150 mg (N = 35) intra venously daily or omeprazole 40 mg (N = 32) daily orally or by nasogas tric route. Patients were monitored for clinically important bleeding. There was no statistically significant difference between treatment g roups in the number of patients enrolled, gender, race, or age. The st udy groups were comparable in regard to the severity of illness based on their similar APACHE II score, duration of ICU stay, duration of ve ntilator dependence, and mortality rate. A significant difference was found only in regard to the number of risk factors per patient, The ra nitidine-treated group had 2.7 risk factors per patient while the omep razole-treated group had 1.9 (P < 0.05). Eleven patients (31%) given r anitidine and two patients (6%) given omeprazole developed clinically important bleeding (P < 0.05). Nosocomial pneumonia developed in five patients (14%) receiving ranitidine and one patient (3%) receiving ome prazole (P > 0.05). We conclude that oral omeprazole is safe, effectiv e, and clinically feasible for stress ulcer prophylaxis.