Complications of SRES

Nosocomial Pneumonia

The increase in gastric pH that follows the use of acid suppression therapy can permit gram-negative bacterial overgrowth, which is believed to be associated with an increased risk of nosocomial pneumonia. Unlike antacids and H2RAs, sucralfate does not significantly elevate gastric pH and is accordingly associated with less gastric bacterial overgrowth. Moreover, an antibacterial mode of action for sucralfate has been suggested. A meta-analysis of trials by Cook and colleagues (1996) examined the drug class specific rates of nosocomial pneumonia and concluded that sucralfate causes significantly less nosocomial pneumonia. However, the results of various studies evaluating the risk of nosocomial pneumonia are widely inconsistent. This is perhaps explained by differing definitions of pneumonia, small samples evaluated, and lack of blinding. As previously stated, a large study comparing sucralfate and ranitidine for the prevention of SRES-related bleeding in 1,200 patients requiring mechanical ventilation showed no significant differences in the rates of nosocomial pneumonia between the two groups. Taking all these issues into consideration, it appears that the positive attributes of H2RAs outweigh the possible risk of nosocomial pneumonia associated with their use. IV administration of H2RAs (or possibly PPIs) may obviate the need for a naso gastric tube, which may also serve as a conduit for migration of bacteria from the stomach to the pharynx. Further outcome studies will be necessary before definite clinical conclusions can be drawn regarding any comparisons of sucralfate with antisecretory therapies.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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