Sucralfate versus antacids or H2-antagonists for stress ulcer prophylaxis: a meta-analysis on efficacy and pneumonia rate.
OBJECTIVE
Histamine2 (H2)-receptor antagonists and antacids have been the basic drugs for the prevention of stress bleeding in ICU patients during the past decade. Recently, drugs without major influence on gastric pH have been investigated in stress bleeding prophylaxis. Therefore, a meta-analysis (Mantel-Haenszel test) was undertaken to determine the efficacy of sucralfate in the prevention of macroscopically visible stress bleeding, as well as the influence of sucralfate on the frequency of pulmonary infections.


RESULTS
The efficacy of sucralfate was compared with H2-antagonists in nine studies and with antacids in eight studies. Sucralfate was significantly more effective than H2-antagonists (typical odds ratio 0.532, 95% confidence interval 0.303 to 0.933) and equally as effective as antacids (typical odds ratio 0.868, 95% confidence interval 0.452 to 1.667). The pneumonia rates of those patients who were administered sucralfate were compared with the rates of those patients who were given H2-antagonists in five studies and with those patients who were given antacids in four studies. Pneumonia was a significantly more frequent occurrence under prophylaxis with H2-antagonists (typical odds ratio 0.498, 95% confidence interval 0.316 to 0.783) as well as with antacids (typical odds ratio 0.402, 95% confidence interval 0.235 to 0.687).


CONCLUSIONS
Sucralfate is an effective drug for the prevention of stress bleeding that minimizes the risk of nosocomial pneumonia in long-term ventilated ICU patients.
Department of Anesthesiology, University of Bochum Bergmannsheil, FRG.
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Tryba
D000863:Antacids / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D016001:Confidence Intervals; D003428:Cross Infection / Q000139:chemically induced / Q000453:epidemiology*; D006635:Histamine H2 Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007362:Intensive Care Units; D015201:Meta-Analysis as Topic; D010437:Peptic Ulcer / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D011014:Pneumonia / Q000139:chemically induced / Q000453:epidemiology*; D012307:Risk Factors; D013312:Stress, Physiological / Q000150:complications*; D013392:Sucralfate / Q000008:administration & dosage / Q000627:therapeutic use*
D000863:Antacids; D006635:Histamine H2 Antagonists; D013392:Sucralfate