BACKGROUND: No surveys of stress ulcer prophylaxis prescribing in the USA have been conducted since 1995. Since that time, the most comprehensive meta-analysis and largest randomized study to date concerning stress ulcer prophylaxis have been published. RESULTS: Three hundred sixty-eight surveys were sent to all members of the Section of Pharmacy and Pharmacology of the Society of Critical Care Medicine. One hundred fifty-three (42%) surveys were returned. Representatives from 86% of institutions stated that medications for stress ulcer prophylaxis are used in a majority (>90%) of patients admitted to the intensive care unit (ICU). Twenty-two per cent of institutions have recommendations for both ICU and non-ICU settings. Fifty-eight per cent of institutions stated that there was one preferred medication for stress ulcer prophylaxis, and in 77% of these histamine-2-antagonists were the most popular. CONCLUSIONS: There are wide variations in prescribing practices for stress ulcer prophylaxis. Institutions should consult published literature and use pre-existing guidelines as templates for developing their own guidelines.