Prospective, randomized comparison of lansoprazole suspension, and intermittent intravenous famotidine on gastric pH and acid production in critically ill neurosurgical patients.
BACKGROUND
There is a paucity of studies comparing stress ulcer prophylaxis (SUP) agents in high-risk neurosurgical patients.


METHODS
In this prospective, randomized study, critically ill neurosurgical patients received lansoprazole 30 mg suspension via NG/NJ tube daily or famotidine 20 mg IV q12 h for SUP. Gastric pH and residual volumes were recorded for 3 days and adverse events for 7 days after admission.


RESULTS
There were 51 patients randomized to lansoprazole (n = 28) or famotidine (n = 23) who received SUP for ≥ 3 days. All patients had at least two risk factors for SRMD, and 75% had a baseline GCS < 9. On day 1 of therapy, more famotidine patients had a gastric pH ≥ 4 at least 80% of the time as compared to lansoprazole patients (74 vs. 36%, P = 0.01, respectively); however, there was no difference on days 2 and 3. Enteral feedings on day 1 predicted a pH ≥ 4 (P = 0.01). There were no significant differences in the percentages of time gastric residual volumes < 28 ml (P = NS). Heme-positive aspirates were present in 18-39% of patients (P = NS); one patient receiving famotidine met the criteria for overt bleeding. Thrombocytopenia occurred in 17% in the famotidine group and 4% in the lansoprazole group (P = NS).


CONCLUSIONS
Neurosurgery ICU patients receiving famotidine for SUP achieved a gastric pH ≥ 4 more often than lansoprazole-treated patients, but only on day 1 of the 3-day study period. Both agents were equally effective in reducing gastric acid production. There was no difference in the incidence of mucosal damage and thrombocytopenia.
Brophy
Gretchen M
GM
Departments of Pharmacotherapy & Outcomes Sciences and Neurosurgery, Virginia Commonwealth University School of Pharmacy, P.O Box 980533, 410 N. 12th Street, Richmond, VA 23298, USA. gbrophy@vcu.edu
Brackbill
Marcia L
ML
Bidwell
Katherine L
KL
Brophy
Donald F
DF
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016638:Critical Illness / Q000628:therapy*; D015738:Famotidine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005745:Gastric Acidity Determination; D005750:Gastric Juice / Q000187:drug effects / Q000502:physiology; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007275:Injections, Intravenous; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011446:Prospective Studies; D044469:Racial Groups; D013535:Suspensions; D055815:Young Adult
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D013535:Suspensions; D064747:Lansoprazole; D015738:Famotidine