The case against stress ulcer prophylaxis in 2007

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Hospital Pharmacy


It seems the story of SUP has now come full circle. SRMD is no longer a frequent and deadly complication in the modern-day ICU. The current incidence is so low that it is unlikely we will have a single trial that is large enough to definitively answer whether SUP is beneficial to critically ill patients. Thus, as stated by Kahn et al. (2006), the decision to initiate SUP will largely depend on clinician assumptions regarding the risk of GI hemorrhage compared with the infectious complications that may arise during therapy.28 Given these unresolved infectious issues as well as the lack of a mortality benefit with the provision of SUP, under the tenet of primum non nocere, a clinician may be justified in choosing to withhold SUP.29 It is imperative that clinicians be aware of the questionable efficacy of SUP, the potential risks of therapy and that these factors are considered when determining the need for SUP in critically ill patients.

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