Erythromycin and the gut.

Abstract

The commonly reported gastrointestinal side effects-that occur with erythromycin are related to its prokinetic action on the gut, mediated, at least in part, by its motilin receptor stimulating activity. This action may be of clinical use in conditions associated with gastrointestinal hypomotility such as diabetic gastroparesis and intestinal pseudo-obstruction, although further work needs to be done to establish the long term therapeutic uses of erythromycin in these disorders. Macrolide compounds with no antibacterial properties but which have a pronounced prokinetic action on the gut have already been synthesised and are currently being developed for future use in man. These 'motilides' should provide a useful addition to our rather limited armamentarium of effective gastrointestinal prokinetic agents.

Meal-Induced Acceleration of Tablet Transit Through the Human Small Intestine

“…Stronger evidence of a food effect on intestinal transit was noted by Digenis et al (14) who administered enteric coated erythromycin pellets 30 min before food and measured a 50% decrease in bioavailability with this dosing regimen; this was attributed to a more rapid small intestinal transit of the dosage form. This study, however, was complicated by the fact that erythromycin is a prokinetic drug which stimulates gastric and duodenal motility (23). In another study in which a pre-feed dose of radiolabelled particles was given 90 min before food, no transit effects were seen (16).…”

Nasoenteral feeding tube placement by nurses using an electromagnetic guidance system (with )

“…Also, prokinetic drugs such as metoclopramide and erythromycin have been used. 13,14 Maneuvers to reach the duodenum include the corkscrew method and use of external magnetic guidance. These methods are successful in 89% to 92% of cases.…”

Adverse Effects of Antimicrobials via Predictable or Idiosyncratic Inhibition of Host Mitochondrial Components

“…Generalized adverse events are common to most antibiotics (e.g., gastrointestinal distress with any oral antibacterial drug), but certain antibiotics are associated with specific effects (Table 1). Some adverse events are mild, e.g., yellowing of the teeth for tetracyclines (77,79), increased intestinal peristalsis related to erythromycin therapy (7,67), and reversible orange discoloration of skin and body fluids as observed with rifampin treatment (23,31). Altered drug metabolism (106) is a common side effect that, in the absence of co-drug therapy, could also be considered mild.…”