Comparison of the efficacy of esomeprazole and famotidine against stress ulcers in a neurosurgical intensive care unit

SummaryBackgroundTo compare the efficacy of esomeprazole and famotidine against stress ulcers and the association of these prophylactic agents with ventilator-associated pneumonia in patients admitted to neurosurgical intensive care unit (ICU).Patients and MethodsSixty patients were randomly allocated into two groups (the esomeprazole and famotidine groups; n = 30 each) to receive prophylaxis medication for 7 days within 24 hours of admission in a neurosurgical ICU. Patients in the esomeprazole group received esomeprazole (40 mg) dissolved in water once a day through a nasogastric tube, whereas patients in the famotidine group received an intravenous infusion of famotidine (20 mg) every 12 hours. We then compared the occurrence of overt upper gastrointestinal bleeding and ventilator-associated pneumonia between these two groups.ResultsOne patient in the famotidine group had overt upper gastrointestinal bleeding (3.3%), whereas the bleeding was not observed in patients in the esomeprazole group. Ventilator-associated pneumonia occurred in one patient (3.3%) from each group. One patient died within 30 days (3.3%) in the esomeprazole group and three patients (10%) died in the famotidine group. There was no difference in the occurrence of overt upper gastrointestinal bleeding (p = 1.000), ventilator-associated pneumonia (p = 1.000), and 30-day mortality (p = 0.612) between these two groups.ConclusionIn this small-scale study, the effect of administration of esomeprazole through a nasogastric tube on stress ulcer was similar to that of intravenous famotidine infusion in neurosurgical ICU patients. In addition, the association between prevalence of ventilator-associated pneumonia and administration of esomeprazole was also similar to that observed with famotidine infusion.