Cimetidine and the potential risk of postoperative sepsis

Abstract

The gastric microflora of patients receiving cimetidine for duodenal ulceration has been investigated and the results compared with those from a group of untreated patients. Cimetidine-induced hypochlorhydria allows bacterial proliferation in the stomach; 75 per cent of aspirates from 44 fasting patients taking cimetidine 1 g daily were found to contain bacteria 2--4 h after the last dose. Of 41 patients taking cimetidine 400 mg at night, 34 per cent still had bacteria in their aspirates 12--13 h later. Patients treated with cimetidine are likely to be at an increased risk of postoperative sepsis. The drug should either be withdrawn before gastric surgery is undertaken or patients with gastric contents of pH 4 or above should receive antibiotic cover.

Phlegmonous gastritis in a patient with rheumatoid arthritis

“…cimetidine) or proton pump inhibitors, the bacteria may also multiply excessively in the gastric juice. When this is the case, the risk of agents invading the gastric wall is significantly higher [8,9]. In some patients the gastric mucosa is damaged due to the effect of alcohol, chemicals, drugs, bacterial toxins from inflammations at different sites, mycotic infection, chronic gastritis, lowered pH of gastric acid and disseminated strongyloidosis [2,[10][11][12][13].…”

Twice-daily cimetidine does not increase gastric bacterial flora

“…(Deane et al, 1980;Ruddell et aL, 1980;Muscroft et al, 1981a;Stockbrugger et al, 1981). Important to any potential role in carcinogenesis is the metabolic activity of such bacteria and the length of time for which they maintain that activity in the stomach.…”

“…Patients were studied 10-5 hr after their last (evening) cimetidine dose in preference to immediately after their morning dose. Muscroft et al (1981a) showed that of 41 patients taking cimetidine, 400 mg at night, 34% had significant bacteria in their aspirates 12-13 hr later, whilst Longstreth, Go and Malagelada (1976) found three out of six patients to be anacid 8 hr after a single 400 mg cimetidine dose.…”

“…Muscroft et aL (1981a) analysed gastric aspirates from 51 untreated DU patients and found 88% to be sterile. Only two aspirates contained more than 106 organisms/ml.…”

Omeprazole: Implications for Therapy of Peptic Ulcer and Reflux Oesophagitis

“…This bacterial overgrowth of the stomach might increase the formation of potentially carci nogenic nitrosamines. However, this has also been observed during cimetidine treatment [20][21][22][23][24][25]. Long-term and widespread use of the Hi-receptor blockers has not been shown to cause an increased incidence of gastric carcinoma.…”