Azithromycin versus erythromycin infusions prior to endoscopy in upper gastrointestinal bleeding

Abstract

Background: Intravenous erythromycin prior to endoscopy for upper gastrointestinal bleeding (GIB) improves outcomes but requires immediate preparation delaying administration in emergency cases.Azithromycin is readily available and does not require prolonged preparation. The aim of the study was to assess the effect of azithromycin in improving the quality of endoscopic visualization in upper GIB compared to erythromycin.Methods: Patients admitted with upper GIB who received erythromycin or azithromycin before urgent endoscopy were included. Primary outcome of the quality of visualization was assessed by two gastroenterologists, blinded to the choice of infusion, using a scoring system ranging from 0 to 8, with a maximum of 2 points assigned to the fundus, body, antrum and bulb.Results: Sixty-six patients were included; 25 received azithromycin and 41 received erythromycin. Mean total visualization score was significantly higher with azithromycin compared to that with erythromycin (6.8±1.4 vs. 5.5±2.2, respectively; P=0.01) and remained significant after adjusting for confounders (Diff: 0.01, 1.88; P=0.05). Secondary outcomes analyses showed a shorter LOS when given azithromycin compared to erythromycin [6 (3 to 9) vs. 8 (7 to 16) days, respectively, 95% CI: 1.03, 3.89; P=0.04]. Time between initiating the infusion and endoscopy was longer with azithromycin (Diff: 40.64 min; 95% CI: 7.23, 74.05; P=0.02). Need for second look endoscopy, procedure time, blood transfusion requirements and procedurerelated complications did not differ between the groups.Conclusions: Azithromycin infusion before endoscopy for upper GIB was associated with better visualization than that of erythromycin. Randomized trials are needed to validate these findings.

Use of prokinetic agents in hospitalised adult patients: A scoping review

“…The most studied outcome in the non‐ICU setting was the quality of the endoscopic procedure such as ability to identify source of bleeding, rate of complications, quality of visualisation and duration of endoscopy (37%) 68,71–73,88–91,93,96,103–107,114 . This was followed by gastric emptying (28%) 58–60,62–66,79,86,87,94 and recovery of bowel function, such as time to flatus or bowel movement primarily after surgery (28%) 38,74,75,78–82,87,98,110,112 …”

“…We included 102 studies with a total of 8830 patients (Figure 1). Eighty‐six studies (84%) were clinical trials 13–98 and 16 (14%) were observational studies 99–114 . Nine studies (7%) were only available in the form of a conference abstract; seven clinical trials and two observational studies 88–93,96,100,107 .…”

“…Twenty‐eight studies (65%) 38,53,59,61,68,72–75,78–82,87–91,93,97,98,106,107,109,110,112,114 reported patient‐centred outcomes including hospital LOS, mortality, surgical complications, infections, need for surgery and readmission rate.…”

“…Seven of the included observational studies (44%) were conducted in the ICU setting, [99][100][101][102]108,111,113 and in the non-ICU setting, respectively (44%). [103][104][105]109,110,112,114 Two observational studies (12%) 106,107 provided no data on study setting. Ten observational studies were retrospective.…”

“…The most studied prokinetic agent in both ICU and non-ICU settings was metoclopramide (49%) followed by erythromycin (31%). 18,20,21,24,25,28,33,34,36,[40][41][42]45,46,49,52,56,59,60,67,69,70,[72][73][74]84,93,96,[100][101][102]105,106,109,113,114 Other agents included serotonin receptor agonists (cisapride, mosapride, prucalopride, TAK-954) (18%) and dopamine antagonists (domperidone and itopride) (10%). Five studies investigated alternative interventions as prokinetic agents, for example, three studies investigated acupuncture.…”