Darrell S. Pardi, MD
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Pardi DS. Optimal Acid Suppression Therapy in Critically Ill Patients. Ann Intern Med. 2000;132:923-924. doi: 10.7326/0003-4819-132-11-200006060-00021
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Published: Ann Intern Med. 2000;132(11):923-924.
TO THE EDITOR:
The Update in Hospital Medicine (1) was interesting and useful. I would like to comment on the heading used above the review of the article by Cook and colleagues (2). This paper showed that intravenous ranitidine therapy was superior to sucralfate for the prevention of clinically important gastrointestinal bleeding in mechanically ventilated patients. However, I do not agree that this study supports the heading chosen in the Update: “H2-Receptor Antagonists Should Be the Prophylactic Drug of Choice in Critically Ill Patients.”
Although Cook and colleagues showed that ranitidine was superior to sucralfate, others have shown that omeprazole is superior to ranitidine for stress ulcer prophylaxis (3, 4) and is less expensive (4). Furthermore, omeprazole can be suspended in bicarbonate solution and given through a nasogastric tube for critically ill patients who also require mechanical ventilation (4, 5). Therefore, I believe that the heading used in the Update is incorrect and misleading. Better acid suppression and less gastrointestinal bleeding can be achieved with proton-pump inhibitors.
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