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Centre for Evidence-
Based Medicine

Critically ill trauma patients - Sucralfate is associated with lower infection rate than ranitidine

Clinical Bottom Line

  1. Sucralfate is associated with a lower incidence of infectious complications than ranitidine in critically ill trauma patients.
  2. The number of patients needed to be treated with sucralfate rather than ranitidine to avoid one infectious complication is 5.

Citation

Keefe GE, Gentilello LM, and Maier RV. Incidence of infectious complications associated with the use of Histamine-2-receptor antagonists in critically ill trauma patients. Annals of Surgery 1998;227:120-125.

Clinical Question

In critically ill trauma patients with gastric erosions is sucralfate or ranitidine associated with fewer infectious complications?

Search Terms

From our ITU colleagues desk top reprint or from MEDLINE using "sucralfate" and "infection"

The Study

Data were extracted from a randomised controlled trial to compare sucralfate with ranitidine in the control of stress gastritis in critically ill trauma patients. The data concerning pneumonia incidence were collected prospectively, other infectious complications were obtained from the records retrospectively.

The Evidence

Infectious complications Totals
Present Absent
Treated with ranitidine

75.5%

a

b

a + b

Treated with sucralfate

55.3%

c

d

c + d

a + c

b + d

a + b + c + d

Relative Risk (RR) = 75.5%/55.3%
= 1.36
p = 0.04

Comments

  1. Sucralfate is associated with fewer infectious complications than ranitidine in the treatment of critically ill patients with gastric erosions.
  2. The mechanism leading to this finding is unknown but it is suggested that it may be due to the more general effects on the immune system of H2 antagonism.

Appraised By

W Rosenberg 1999

Expiry Date

2000