Stress ulcer prophylaxis guidelines: Are they being implemented in Lebanese health care centers?

Table 1 American Society of Health-System Pharmacists recommendations for stress ulcer prophylaxis

Population	Treatment recommendations	Grade
Non-critically ill medical and surgical patients	Prophylaxis not recommended	B1
Critically ill patients with one of the following:
Coagulopathy (i.e. platelet count of < 50 000 mm3, INR of 1.5)	Prophylaxis recommended	C
Mechanical ventilation for > 48 h		C
History of gastrointestinal ulceration or bleeding within 1 year of admission		D
Glasgow Coma score of ≤ 10		B, D2
Thermal injury to > 35% of body surface area		B, D3
Partial hepatectomy		C, D4
Multiple trauma (injury severity score of ≥ 16)		D
Hepatic or renal transplantation		D
Spinal cord injury		D
Hepatic failure		D
Two or more of the following risk factors: sepsis, ICU stay of greater than 1 wk, occult bleeding lasting at least 6 d, and high-dose corticosteroids (> 250 mg/d of hydrocortisone or equivalent daily)		D
Pediatric patients with one of the following:
Respiratory failure	Prophylaxis recommended	C
Coagulopathy		C
Pediatric Risk of Mortality Score of ≥ 10		C
Thermal injuries		D

¹Strength of evidence = B for general medical and surgical patients with fewer than two risk factors for clinically important bleeding; strength of evidence = D for patients with two or more risk factors;

²Strength of evidence = B for histamine H2-receptor antagonist (H2-RAs); strength of evidence = D for antacids and sucralfate;

³Strength of evidence = B for antacids; strength of evidence = D for H2-RAs and sucralfate;

⁴Strength of evidence = C for H2-RAs; strength of evidence = D antacids and sucralfate. INR: International normalized ratio; ICU: Intensive care unit.