Nosocomial pneumonia in mechanically ventilated patients receiving antacid, ranitidine, or sucralfate as prophylaxis for stress ulcer. A randomized controlled trial

Ann Intern Med. 1994 Apr 15;120(8):653-62. doi: 10.7326/0003-4819-120-8-199404150-00005.


Objective: To assess three anti-stress ulcer prophylaxis regimens in mechanically ventilated patients for bacterial colonization, early- and late-onset nosocomial pneumonia, and gastrointestinal bleeding.

Design: Randomized controlled trial.

Patients: Consecutive eligible patients with mechanical ventilation and a nasogastric tube. Of 258 eligible patients, 244 were assessable.

Setting: Medical and surgical intensive care units.

Intervention: At intubation, patients were randomly assigned to receive one of the following: antacid (a suspension of aluminum hydroxide and magnesium hydroxide), 20 mL every 2 hours; ranitidine, 150 mg as a continuous intravenous infusion; or sucralfate, 1 g every 4 hours.

Measurements: Using predetermined criteria, the incidence of gastric bleeding, gastric colonization, early-onset pneumonia, and late-onset pneumonia was assessed in patients intubated for more than 24 hours.

Results: Of 244 assessable patients, macroscopic gastric bleeding was observed in 10%, 4%, and 6% of patients assigned to receive sucralfate, antacid, and ranitidine, respectively (P > 0.2). The incidence of early-onset pneumonia was not statistically different among the three treatment groups (P > 0.2). Among the 213 patients observed for more than 4 days, late-onset pneumonia was observed in 5% of the patients who received sucralfate compared with 16% and 21% of the patients who received antacid or ranitidine, respectively (P = 0.022). Mortality was not statistically different among the three treatment groups. Patients who received sucralfate had a lower median gastric pH (P < 0.001) and less frequent gastric colonization compared with the other groups (P = 0.015). Using molecular typing, 84% of the patients with late-onset gram-negative bacillary pneumonia were found to have gastric colonization with the same bacteria before pneumonia developed.

Conclusion: Stress ulcer prophylaxis with sucralfate reduces the risk for late-onset pneumonia in ventilated patients compared with antacid or ranitidine.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antacids / therapeutic use*
  • Cross Infection / etiology*
  • Cross Infection / mortality
  • Equipment Contamination
  • Female
  • Gastric Acidity Determination
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Peptic Ulcer Hemorrhage / etiology
  • Peptic Ulcer Hemorrhage / mortality
  • Pneumonia / etiology*
  • Pneumonia / mortality
  • Ranitidine / therapeutic use*
  • Respiration, Artificial / adverse effects*
  • Stress, Physiological / complications
  • Sucralfate / therapeutic use*
  • Time Factors
  • Ulcer / etiology
  • Ulcer / prevention & control*


  • Antacids
  • Sucralfate
  • Ranitidine