Ojiako and colleagues1 report a retrospective study comparing the effectiveness of famotidine and pantoprazole to prevent stress ulcers in critically ill patients receiving mechanical ventilation. This study showed that patients in the pantoprazole group were sicker and had a significantly higher incidence of upper gastrointestinal bleeding than did patients in the famotidine group (0.38% vs 3.2%, P = .03).

The evidence for histamine-2 receptor antagonists (H2RAs) is much stronger than that for proton pump inhibitors (PPIs) in this clinical setting. In current practice, H2RAs (eg, famotidine) are the first-line agents for stress ulcer prophylaxis in critically ill patients, and PPIs (eg, pantoprazole) are generally used in patients who were perceived to be at higher risk (eg, those with previous history of peptic ulcer disease). If the risk profiles were similar, one would not use...

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