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Critical illness gastrointestinal hypomobility disorder and success of enteral erythromycin

Introduction

Erythromycin is the most potent prokinetic drug available. It is commonly used intravenously. The aim of our study was to determine the effective lowest dose of enteral erythromycin, its tolerability and comparing the dose with the severity of the disease and outcome.

Methods

All patients admitted to the trauma ICU between January 2004 and January 2008 who developed feeding intolerance were included (residual volume >500/24 hours). The starting dose was 125 mg erythromycin twice daily; if no response, the dose was increased up to a maximum of 1 g twice daily. Data were entered in SPSS software. The chi-square test + one-way ANOVA with post hoc analysis were used. P < 0.05 was significant.

Results

One hundred and seven patients were included, with 85% being male, average age 41 ± 18 years. The majority of patients (54%) suffered from traumatic brain injury, 74% were ventilated, 51% on inotropes, 55% on three opioids, 84% on enteral feeding. The Sequential Organ Failure Assessment score was significantly higher and the Glasgow coma scale was significantly lower in patients receiving 1 g erythromycin (P < 0.05). See Table 1.

Table 1 Response rate and outcome related to enteral erythromycin dose

Conclusion

A low dose of enteral erythromycin 125 mg twice daily is potentially effective in patients on intravenous metoclopromide having enteral feeding intolerance. Combining prokinetic therapy and keeping the administration of erythromycin as short as possible can prevent the development of bacterial resistance.

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Shaikh, N., Hanssens, Y. & Kettern, M. Critical illness gastrointestinal hypomobility disorder and success of enteral erythromycin. Crit Care 13, P141 (2009). https://doi.org/10.1186/cc7305

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Keywords

  • Traumatic Brain Injury
  • Brain Injury
  • Emergency Medicine
  • Erythromycin
  • Organ Failure