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Erythromycin dose of 70 mg accelerates gastric emptying as effectively as 200 mg in the critically ill

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Abstract

Objective

To compare the effectiveness of 70-mg and 200-mg doses of intravenous erythromycin in improving gastric emptying in critically ill patients.

Design

Gastric emptying was measured on consecutive days; day 1 (pre-treatment), day 2 (post-treatment) after an intravenous infusion of either 70 or 200 mg erythromycin or saline placebo (0.9%), in a randomized double-blind fashion.

Setting

Mixed medical/surgical intensive care unit, tertiary referral.

Patients and participants

Thirty-five randomly selected, mechanically ventilated, enterally fed critically ill patients (median APACHE II score 19 on admission).

Interventions

On day 2 either 70 or 200 mg erythromycin or saline was administered intravenously over 20 min.

Measurements and results

Gastric emptying was measured using the [13C]octanoic acid breath test. The gastric emptying coefficient (GEC) and half-emptying time (t1/2) were calculated from the area under the 13CO2-recovery curve. Pre-treatment gastric emptying measurements were similar in all three patient groups. Treatment with both doses of erythromycin significantly reduced the gastric t1/2: 70 mg, 98 min (IQR 88–112); 200 mg, 86 min (75–104); vs. placebo, 122 min (102–190) (p<0.05). The GEC was higher with both doses of erythromycin: 70 mg, 3.8 (3.3–4.0); 200 mg, 4.0 (3.6–4.2); vs. placebo, 2.9 (2.5–3.7) (p<0.05). There was no difference in gastric emptying post-treatment between the two doses of erythromycin. The effect of erythromycin was greatest in patients with delayed gastric emptying.

Conclusions

Treatment with 70 and 200 mg intravenous erythromycin are equally effective in accelerating gastric emptying in the critically ill

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Acknowledgements

We thank Virginia Sharley, Pharmacy Department, Royal Adelaide Hospital, and nursing and medical staff of the Intensive Care Unit for their cooperative support of this study. This study was supported by a grant from the National Health and Medical Research Council and by institutional departmental funds. M.A.R. was supported by grants from the Swiss National Foundation of Sciences and the Margarete und Walther Lichtenstein-Stiftung (Basel, Switzerland).

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Authors and Affiliations

  1. Department of Medicine, Royal Adelaide Hospital, 5000, Adelaide, SA, Australia

    Robert J. Fraser

  2. Department of Gastrointestinal Medicine, Royal Adelaide Hospital, 5000, Adelaide, SA, Australia

    Marc A. Ritz

  3. Department of Anaesthesia and Intensive Care, Royal Adelaide Hospital, 5000, Adelaide, SA, Australia

    Marianne J. Chapman, Mark E. Finnis & Deborah Rea

  4. Centre for Paediatric and Adolescent Gastroenterology, Women’s and Children’s Hospital, 5006, Adelaide, SA, Australia

    Ross N. Butler, Patricia Cmielewski & Geoffrey P. Davidson

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  1. Marc A. Ritz
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  2. Marianne J. Chapman
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Correspondence to Robert J. Fraser.

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Ritz, M.A., Chapman, M.J., Fraser, R.J. et al. Erythromycin dose of 70 mg accelerates gastric emptying as effectively as 200 mg in the critically ill. Intensive Care Med 31, 949–954 (2005). https://doi.org/10.1007/s00134-005-2663-8

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  • DOI: https://doi.org/10.1007/s00134-005-2663-8

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