Efficacy and safety of pantoprazole for stress-ulcer prophylaxis in critically ill patients: A systematic review and Meta-analysis of randomized controlled trials
In brief
Pantoprazole cuts clinically important GI bleeding in ICU patients by about half
In a meta-analysis of seven randomized trials involving roughly 9,100 critically ill adults and children, pantoprazole halved the risk of significant gastrointestinal bleeding compared with placebo. The drug did not change overall mortality, ventilator-associated pneumonia, or Clostridioides difficile infection rates. These findings support pantoprazole as an effective, safety-neutral prophylaxis option in the ICU, though clinicians should weigh individual bleeding risk.
- Journal
- Journal of critical care (Q1)
- Published
- 13 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Rahul Falodia, Rabia Ramzan, Tahir Mehmood Khan, Huzaifa Sabir Nawaz, Muhammad Affan, Mohammad Aitzaz Hassan, et al.
- PMID
- 42594423
- DOI
- 10.1016/j.jcrc.2026.155712
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 16 August 2026): Pantoprazole reduces GI bleeding in critically ill patients
- Picked for Pharmacology (medical) (top studies of the week, 16 August 2026): Pantoprazole prophylaxis meta‑analysis in ICU
Abstract
BACKGROUND: Stress-related mucosal damage (SRMD) is common in critically ill patients, and pharmacologic prophylaxis remains essential. This study evaluated the efficacy and safety of pantoprazole for stress-ulcer prophylaxis in ICU patients. MATERIALS AND METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted per PRISMA-2020 guidelines. PubMed, Scopus, and CENTRAL were searched for studies comparing pantoprazole with placebo in adult and pediatric ICU patients. The primary outcome was clinically important gastrointestinal (GI) bleeding; secondary outcomes included mortality, ventilator-associated pneumonia (VAP), and Clostridioides difficile infection. RESULTS: Seven RCTs (n ≈ 9127; pantoprazole = 4575; placebo = 4552) were included. Pantoprazole significantly reduced clinically important GI bleeding (RR = 0.53; 95% CI 0.29-0.94; p = 0.03) without affecting overall mortality (RR ≈ 0.99 [95% CI 0.92-1.05]; p = 0.68). Infection rates were similar between groups (VAP: RR = 0.99; p = 0.78; C. difficile: RR = 1.11; p = 0.73). Sensitivity analyses confirmed robustness. CONCLUSIONS: Pantoprazole effectively reduces clinically important GI bleeding without increasing infection or overall mortality.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.