, Volume 33, Issue 4, pp 718-720
Date: 24 Feb 2007

Recommendations for ulcer prophylaxis in the treatment of patients with severe sepsis and septic shock: a dog chasing its tail?

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The guidelines for the treatment of patients with severe sepsis and septic shock, presented in 2004, take into consideration the problem of gastro-protective treatments [1].

The indications provided by this document prompt the use of agents for stress ulcer prophylaxis in all patients with severe sepsis and septic shock [1, 2], and mark this recommendation as grade A, according to the methodology suggested by Sackett et al. [3]. Treatment with histamine2 (H2) inhibitors, aimed at avoiding gastrointestinal bleeding, is considered “more efficacious than sucralfate”, and a direct comparative study between H2 inhibitors and proton pump inhibitors has never been carried out [1, 2]. Although the authors admit that specific studies on septic patients have never been performed, the literature [4, 5, 6, 7] demonstrates the benefit of prophylaxis on a vast population of critically ill patients, including a number of septic patients [1].

Critical appraisal of all references that represent the evide