Investigating and Comparing the Severity and Prevalence of Ventilator-Induced Pneumonia in Patients Taking Famotidine and Pantoprazole in the Intensive Care Unit: A Clinical Trial

Sanaz  Omidi; Maryam  ShiehMorteza; Amirhossein  Ghanbarzamani

doi:10.18502/aacc.v11i5.19924

Sanaz Omidi Department of Clinical Pharmacy, TeMS.C., Islamic Azad University, Tehran, Iran.
Maryam ShiehMorteza Department of Clinical Pharmacy, TeMS.C., Islamic Azad University, Tehran, Iran.
Amirhossein Ghanbarzamani Department of Clinical Pharmacy, TeMS.C., Islamic Azad University, Tehran, Iran.

DOI: https://doi.org/10.18502/aacc.v11i5.19924

Keywords: Ventilator-associated pneumonia; Pantoprazole; Famotidine; Stress ulcer prophylaxis; Intensive care unit

Abstract

Background: Patients admitted to the intensive care unit (ICU) are at high risk of gastrointestinal (GI) mucosal injury and stress ulcers, which may lead to gastrointestinal bleeding, due to their critical condition and use of mechanical ventilation. Stress ulcer prophylaxis drug regimens, including proton pump inhibitors (PPIs) and histamine type 2 receptor antagonists (H2RAs), are commonly used to prevent these complications. However, there are concerns about the side effects of these drugs, including an increased risk of ventilator-associated pneumonia (VAP). This study aimed to compare the effects of pantoprazole and famotidine on clinical outcomes and the risk of VAP in patients admitted to the ICU.

Methods: This study was designed as a single-center randomized clinical trial conducted in the Intensive Care Unit (ICU). The study population included 138 patients admitted to the ICU who required mechanical ventilation. The treatment regimens studied included two groups: group 1 received intravenous pantoprazole (40 mg daily), and group 2 received intravenous famotidine (20 mg twice daily). The study's primary outcome measure was the incidence of VAP, which was assessed according to ATS/IDSA and CDC guidelines. Other clinical variables included ICU length of stay, APACHE score, and incidence of adverse events.

Results: The results showed that in the famotidine group, ICU length of stay and APACHE II score were significantly shorter than in the pantoprazole group. However, no statistically significant differences were observed in variables such as age, weight, drug administration duration, and intubation duration. In addition, the frequency of death and pneumonia incidence in the famotidine group was lower than in the pantoprazole group, although this difference was not statistically significant.

Conclusion: This study showed that both famotidine and pantoprazole are effective in the prophylaxis of stress ulcers in critically ill ICU patients, but famotidine may be associated with more favorable clinical outcomes, including reduced length of stay and severity of illness. Also, the use of gastric acid suppressant drugs is associated with an increased risk of VAP, which requires more attention to drug selection and patient management. The findings of this study can help in better decision-making regarding the use of SUP drugs in ICU patients.