Prospective, Randomized Comparison of Lansoprazole Suspension, and Intermittent Intervenous Famotidine on Gastric pH and Acid Production in Critically ill Neurosurgical Patients

Background There is a paucity of studies comparing stress ulcer prophylaxis (SUP) agents in high-risk neurosurgical patients. Methods In this prospective, randomized study, critically ill neurosurgical patients received lansoprazole 30 mg suspension via NG/NJ tube daily or famotidine 20 mg IV q12 h for SUP. Gastric pH and residual volumes were recorded for 3 days and adverse events for 7 days after admission. Results There were 51 patients randomized to lansoprazole (n = 28) or famotidine (n = 23) who received SUP for =3 days. All patients had at least two risk factors for SRMD, and 75% had a baseline GCS < 9. On day 1 of therapy, more famotidine patients had a gastric pH = 4 at least 80% of the time as compared to lansoprazole patients (74 vs. 36%, P = 0.01, respectively); however, there was no difference on days 2 and 3. Enteral feedings on day 1 predicted a pH = 4 (P = 0.01). There were no significant differences in the percentages of time gastric residual volumes <28 ml (P = NS). Heme-positive aspirates were present in 18-39% of patients (P = NS); one patient receiving famotidine met the criteria for overt bleeding. Thrombocytopenia occurred in 17% in the famotidine group and 4% in the lansoprazole group (P = NS). Conclusions Neurosurgery ICU patients receiving famotidine for SUP achieved a gastric pH = 4 more often than lansoprazole-treated patients, but only on day 1 of the 3-day study period. Both agents were equally effective in reducing gastric acid production. There was no difference in the incidence of mucosal damage and thrombocytopenia.