Effect of erythromycin on gastric motility in mechanically ventilated critically ill patients

Abstract

In mechanically ventilated patients, intravenous erythromycin (200 mg over 30 mins) increases indices of antral motility and accelerates gastric emptying as assessed by the kinetics of acetaminophen absorption.

Sequential single doses of cisapride, erythromycin, and metoclopramide in critically ill patients intolerant to enteral nutrition: A randomized, placebo-controlled, crossover study

“…53,54 Studies comparing individual agents with placebo have demonstrated prokinetic agents to be effective for promoting gastric emptying in critically ill patients. [22][23][24][25] In a randomized, controlled study of 21 critically ill patients, Spapen et al 22 showed that cisapride promotes gastric emptying as assessed by the volume of gastric residuals and bedside scintigraphy compared with placebo. During the 7-day study period, the mean gastric residual volume was significantly higher and gastric emptying significantly slower in the placebo group than in the cisapride group (p < .005).…”

“…In a randomized, double-blind, placebo-controlled, crossover study of ten critically ill patients, Dive et al 25 demonstrated the erythromycin enhances antral motility and accelerates gastric emptying compared with placebo. The mean number and amplitude of contractions and motility index were increased significantly during the first hour after erythromycin infusion (p < .005).…”

“…We did not demonstrate erythromycin to be effective for promoting gastric emptying compared with placebo or other prokinetic agents. However, our methodology differed because we administered acetaminophen simultaneously with enteral erythromycin; whereas Dive et al 25 administered acetaminophen 60 mins after intravenous erythromycin. Single 38,39,55,56 and repeated doses 38,57-60 of erythromycin have significantly enhanced gastric emptying compared with placebo in studies involving healthy adults 39,55,56 and patients with diabetic gastroparesis 38,57,58 or bowel resection 59,60 ; however, these studies did not utilize the acetaminophen absorption model to assess gastric motility.…”

“…21 The results of studies comparing individual agents with placebo have demonstrated these agents to be effective in increasing gastric emptying, with minimal adverse effects. [22][23][24][25] Unfortunately, these studies were not selective for patients with proven intolerance to EN.…”

“…This model has been used in other studies to assess gastric emptying in subsets of critically ill patients 41,42 and studies evaluating prokinetic agents. [23][24][25]43,44 Most studies to date have used non-compartmental or graphic methods to estimate AUC during a defined period of time (usually the first 60 mins after acetaminophen administration), peak concentration of acetaminophen, and the time at which the peak concentration was observed. However, several limitations exist with using these noncompartmental or graphic methods to evaluate gastric emptying.…”