SUCRALFATE VERSUS ANTACIDS OR H-2-ANTAGONISTS FOR STRESS-ULCER PROPHYLAXIS - A METAANALYSIS ON EFFICACY AND PNEUMONIA RATE

Objectives and Methods: Histamine2 (H-2)-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 H-2-antagonists in nine studies and with antacids in eight studies. Sucralfate was significantly more effective than H-2-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 H-2-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 H-2-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). Conclusion: Sucralfate is an effective drug for the prevention of stress bleeding that minimizes the risk of nonsocomial pneumonia in long-term ventilated ICU patients.