Impact of Intravenous Pantoprazole versus Oral Pantoprazole on Gastric pH in Pediatric Intensive Care Unit: A Randomized Trial

Subject Areas : Journal of Chemical Health Risks

Sara  Salarian ¹ (Pediatric Pathology Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran)
Bahador  Mirrahimi ² (Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran)
Fahimeh  Hadavand ³ (Department of Infectious Diseases, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran)
Mahsa  Gharehdaghi ⁴ (Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran)
Bahador  Bagheri ⁵ (Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran)

Received: 2020-11-19 Accepted : 2021-04-19 Published : 2021-10-01

Keywords: oral, Gastric Acid, Intravenous, Pantoprazole, Pediatric,

Abstract :

Critically ill patients are at risk for development of stress-related mucosal damage (SRMD). Proton Pump Inhibiros (PPIs) like pantoprazole are extensively used to prevent SRMD in ICU settings. It is not known with certainty that either oral or intravenous pantoprazole is associated with a better response. Our goal was to compare effects of intravenous pantoprazole with oral pantoprazole on gastric pH in children admitted to PICU. In this blinded trial, 80 patients were randomly divided into two groups. Patients in in the first group received oral pantoprazole (1 mg/kg/day/divided) and patients in the second received IV pantoprazole (1 mg/kg/day/divided). The gastric pH was measured 48 hours after pantoprazole administration using litmus paper. The mean age was 990 days. After 48 hours, the gastric pH was 4.46 ± 1.48 in patients received pantoprazole orally and it was 4.85 ± 1.52 in patients received pantoprazole intravenously. There was no significant difference between two study groups (P= 0.252). Besides, no significant differences were noted in rate of diarrhea and nosocomial pneumonia between 2 study groups (P > 0.05). This study showed that both intravenous and oral pantoprazole had similar effects on gastric acid of children hospitalized in PICU. It seems reasonable to use oral pantoprazole to reduce the costs of treatment.

References:

1. Deerojanawong J., Peongsujarit D., Vivatvakin B., & PrappHal N., 2009. Incidence and risk factors of upper gastrointestinal bleeding in mechanically ventilated children. Pediatr Crit Care Med Soc Crit Care Med.10(1), 91‑95.

2. Lugo R. A., Harrison A.M., Cash J., Sweeley J., Vernon D. D., 2001. PHarmacokinetics and pHarmacodynamics of ranitidine in critically ill children. Crit Care Med. 29(4), 759‑764.

3. Ferron G.M., Ku S., Abell M., Unruh M., Getsy J., Mayer P.R., Paul J., 2003. Oral bioavailability of pantoprazole suspended in sodium bicarbonate solution. Am J Heal PHarm. 60(13), 1324‑1329.

4. Silen W., 1980. The prevention and management of stress ulcers. Hosp Pract. 15(3), 93‑100.

5. Stollman N., Metz D.C., 2005. PathopHysiology and propHylaxis of stress ulcer in intensive care unit patients. J Crit Care. 20(1), 35‑45.

6. Fennerty M.B., 2002. PathopHysiology of the upper gastrointestinal tract in the critically ill patient: rationale for the therapeutic benefits of acid suppression. Crit Care Med. 30(6), S351‑S355.

7. Ward R.M., Tammara B., Sullivan S.E., Stewart D.L., Rath N., Meng X., Comer G.M., 2010. Single-dose, multiple-dose, and population pHarmacokinetics of pantoprazole in neonates and preterm infants with a clinical diagnosis of gastroesopHageal reflux disease (GERD). Eur J Clin PHarmacol. 66(6), 555‑561.

 8. Metheny N.A., Clouse R.E., Clark J.M., Reed L., Wehrle M.A., Wiersema L., 1994. pH testing of feeding‐tube aspirates to determine placement. Nutr Clin Pract. 9(5), 185‑190.

9. PHillips J.O., Metzler M.H., Palmieri M.T.L., Huckfeldt R.E., Dahl N.G., 1996. A prospective study of simplified omeprazole suspension for the propHylaxis of stress-related mucosal damage. Crit Care Med. 24(11), 1793‑1800.

10. Täubel J.J., Sharma V.K., Chiu Y.L., Lukasik N.L., Pilmer B.L., Pan W.J., 2001. A comparison of simplified lansoprazole suspension administered nasogastrically and pantoprazole administered intravenously: effects on 24‐h intragastric pH. Aliment PHarmacol Ther. 15(11), 1807‑1817.

11. Dabiri Y., Fahimi F., Jamaati H., Hashemian S.M.R., 2015. The comparison of extemporaneous preparations of omeprazole, pantoprazole oral suspension and intravenous pantoprazole on the gastric pH of critically ill-patients. Indian J. Crit. care Med. Peer-reviewed, Off. Publ. Indian Soc Crit Care Med. 19(1), 21.

12. Winter H., Kum-Nji P., Mahomedy S.H., Kierkus J., Hinz M., Li H., Comer G.M. 2010. Efficacy and safety of pantoprazole delayed-release granules for oral suspension in a placebo-controlled treatment-withdrawal study in infants 1–11 months old with symptomatic GERD. J Pediatr Gastroenterol Nutr. 50(6), 609‑618.

13. Bigoniya P., Shukla A., Singh C.S., Gotiya P., 2011. Comparative anti-ulcerogenic study of pantoprazole formulation with and without sodium bicarbonate buffer on pyloric ligated rat. J PHarmacol PHarmacother. 2(3), 179.

14. Kallet R.H., Quinn T.E., 2005. The gastrointestinal tract and ventilator-associated pneumonia. Respir Care. 50(7), 910‑923.

15. Bomers M.K., Menke F.P., Savage R.S., Vandenbroucke-Grauls C.M.J.E., Van Agtmael M.A., Covington J.A., Smulders Y.M., 2015. Rapid, accurate, and on-site detection of C. difficile in stool samples. Am J Gastroenterol. 110(4), 588‑594.

16. Hutchinson C., Geissler C.A., Powell J.J., Bomford A., 2007. Proton pump inhibitors suppress absorption of dietary non-haem iron in hereditary haemochromatosis. Gut. 56(9), 1291‑1295.

17. Jensen R.T., 2006. Consequences of long‐term proton pump blockade: insights from studies of patients with gastrinomas. Basic Clin PHarmacol Toxicol. 98(1), 4‑19.

18. Barton J.C., Adams P.C., Acton R.T., Speechley M., McLaren C.E., McLaren G.D., Eckfeldt J.H., 2013. Proton pump inhibitors and lower serum ferritin levels in 171 HFE C282Y homozygotes in the hemochromatosis and iron overload screening study. Vitam. Trace Elem. 2, 1000112.

19. Filion K.B., JosepH L., Boivin J.F., Suissa S., BropHy J.M., 2011. Thiazolidinediones and the risk of incident congestive heart failure among patients with type 2 diabetes mellitus. PHarmacoepidemiol. Drug Saf. 20(8), 785‑796.

20. Gomm W., von Holt K., Thomé F., Broich K., Maier W., Fink A.,Haenisch B., 2016. Association of proton pump inhibitors with risk of dementia: a pHarmacoepidemiological claims data analysis. JAMA Neurol. 73(4), 410‑416.

21. Lazarus B., Chen Y., Wilson F. P., Sang Y., Chang A. R, Coresh J., Grams M.E., 2016. Proton pump inhibitor use and the risk of chronic kidney disease. JAMA Intern Med.176(2), 238‑246.

22. Eghbali A., Khalilpour A., Taherahmadi H., Bagheri B., 2019. Pantoprazole reduces serum ferritin in patients with thalassemia major and intermedia: A randomized, controlled study. Therapie.74(5), 507-512.

23. Mutlu, E. A., & Factor, P. 2001. GI complications in patients receiving mechanical ventilation. Chest. 119(4), 1222‑1241.

24. Chen W.C., Li Y.D., Chiang P.H., Tsay, F.W., Chan H.H., Tsai W.L., Lai K.H., 2014. Comparison of proton pump inhibitor and histamine-2 receptor antagonist in the prevention of recurrent peptic ulcers/erosions in long-term low-dose aspirin users: a retrospective cohort study. Biomed Res Int. 2014, 693567.

25. Alshamsi F., Belley-Cote E., Cook D., Almenawer S.A., Alqahtani Z., Perri D., Guyatt G., 2016. Efficacy and safety of proton pump inhibitors for stress ulcer propHylaxis in critically ill patients: a systematic review and meta-analysis of randomized trials. Crit Care. 20(1), 1‑12.