Цитата:
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Сообщение от Paspartu
Не совсем понятно в отношении сравнительной эффективности Н2-блокаторов и омепразола(Лосек)-не рассматриваются противопоказания к Лосеку."Наши" настаивают на последнем, зарубеж не столь категоричен
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Недавнее исследование показало "примерно" одинаковую эффективность оральной суспензии омепразола по сравнению с постоянной инфузией циметидина:
Crit Care Med. 2005 Apr;33(4):760-5.
Randomized, double-blind comparison of immediate-release omeprazole oral suspension versus intravenous cimetidine for the prevention of upper gastrointestinal bleeding in critically ill patients.
Conrad SA, Gabrielli A, Margolis B, Quartin A, Hata JS, Frank WO, Bagin RG, Rock JA, Hepburn B, Laine L.
Louisiana State University, Shreveport, LA, USA.
OBJECTIVE: To demonstrate that a new immediate-release omeprazole oral suspension is effective in preventing upper gastrointestinal bleeding in critically ill patients. DESIGN: A noninferiority analysis was used to compare rates of clinically significant upper gastrointestinal bleeding in a prospective, phase 3, double-blind trial with parallel omeprazole suspension and cimetidine treatment groups. SETTING: A total of 47 intensive care units in the United States. PATIENTS: A total of 359 critically ill patients who required mechanical ventilation for > or =48 hrs, had an Acute Physiology and Chronic Health Evaluation score of > or =11 at baseline, had an intact stomach with a nasogastric or orogastric tube in place, and had at least one additional risk factor for upper gastrointestinal bleeding. INTERVENTIONS: Patients were randomized to treatment with omeprazole suspension (two 40-mg doses on day 1, via orogastric or nasogastric tube, and 40 mg each day thereafter) or intravenous cimetidine (300-mg bolus and 50 mg/hr thereafter) for up to 14 days. Gastric aspirates were sampled for bleeding and pH. Medication doses were doubled for failure of pH control (two successive aspirates with pH < or = 4). MEASUREMENTS AND MAIN RESULTS: Clinically significant upper gastrointestinal bleeding (bright red blood not clearing after 5-10 mins of lavage or persistent Gastroccult-positive "coffee-grounds" material for 8 hrs on days 1-2 or for 2-4 hrs on days 3-14 and not clearing with > or =100 mL of lavage) was the primary end point of the trial. The rate of clinically significant bleeding in the per-protocol population was 4.5% with omeprazole suspension and 6.8% with cimetidine, meeting the criteria for the noninferiority of omeprazole suspension. Median gastric pH was > or =6 on all trial days with omeprazole suspension treatment and on 50% of days with cimetidine treatment (p < .001, all trial days). In the omeprazole suspension group, median gastric pH was >4 on each trial day in 95% of patients. CONCLUSIONS: Immediate-release omeprazole suspension is effective in preventing upper gastrointestinal bleeding and more effective than intravenous cimetidine in maintaining gastric pH of >4 in critically ill patients.
Предыдущeе исследованиe показалo, что в/в омепразол каждые 12 ч выглядит несколько получше, чем сукральфат или в/в ранитидин:
In a small randomized study of 108 patients who were at risk for SRMD, the efficacy of the PPI omeprazole (50 mg i.v. every 12 hours) in preventing overt GI bleeding was compared with that of sucralfate (1 g orally every 6 hours) and i.v. ranitidine (150 mg/day). The incidence of overt bleeding was 0% with omeprazole, 9.3% with sucralfate, and 10.5% with ranitidine.
Azevedo JR, Soares MG, Silva C et al. Prevention of stress ulcer bleeding in high risk patients: comparison of three drugs. Crit Care Med. 1999; 27:A145
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Некоторые соображения экспертов:
For the past several years, H2RAs have been preferentially used over PPIs in the hospital setting because H2RAs are available in liquid and intravenous formulations, easing administration problems in the critically ill. However, extemporaneously compounded oral PPI suspensions and the recently approved intravenous formulations of pantoprazole and lansoprazole have eliminated some of the administration issues previously associated with PPIs. Additionally, study data with PPI formulations suggest efficacy in stress ulcer prophylaxis compared with H2RAs.
Metz DC.
Preventing the gastrointestinal consequences of stress-related mucosal disease.
Curr Med Res Opin. 2005 Jan;21(1):11-8. Review