Cimetidine in the prophylaxis of stress ulceration in severely burned patients

The role of cimetidine in the treatment of acute stress erosions during the first two days following major thermal injury was evaluated. Twelve patients with bums of greater than 30% total body surface area were randomized and prospectively evaluated to determine the efficacy of two treatment regimens in the control of gastric acidity. Group A was treated with an intensive antacid regimen and cimetidine placebo; group B was treated with the same antacid protocol plus a standard regimen of parenteral cimetidine. Gastric acidity was monitored continuously by the use of an indwelling pH probe. Patients in group B experienced better pH control (P <0.01) and required fewer doses of antacid during the study period (P <0.005). Patients receiving combined therapy also required fewer interruptions in gastric decompression procedures. It was concluded that cimetidine should be part of acute stress erosion treatment regimens during the period of fluid resuscitation for bum shock until resumption of oral intake. Combined therapy with antacid and cimetidine improves gastric pH control compared to antacid alone and reduces risks of side effects associated with intensive antacid dosing and frequent interruptions of gastric decompression.