A randomized, double-blind trial for stress ulcer prophylaxis shows no evidence of increased pneumonia

Background: H2-receptor antagonists are commonly used for stress ulcer prophylaxis on intensive care units. However, there is evidence that via the route of an elevated gastric pH, followed by bacterial overgrowth and subsequent tracheal aspiration, pneumonia could occur. In line with this assumption total gastrectomized patients should develop a very high incidence of pneumonia, which is actually not the case. We therefore formulated the hypothesis that stress ulcer prophylaxis with H2-receptor antagonists does not lead to an increased pneumonia rate. Methods: A total of 158 patients with mechanical ventilation ≥48 hours of a surgical intensive care unit were randomized to the following groups: A, placebo (n = 57); B, pirenzepine (3 × 10 mg intravenously, n = 44); and C, ranitidine (3 × 50 mg intravenously, n = 57). Results: The pneumonia rate in ranitidine-, pirenzepine-, and placebo-treated patients is 10 of 57, 10 of 44, and 12 of 57, respectively. Conclusions: Pneumonia rate is not adversely affected by H2-receptor antagonists in stress ulcer prophylaxis.