Background and Importance Critically patients sometimes suffer from gastrointestinal disorders which are necessary to treat to improve clinical outcomes. Erythromycin is an antibiotic with prokinetic activity due to its agonist activity on motilin receptors, accelerating gastric emptying.
Aim and Objectives To evaluate the efficacy of intravenous erythromycin as a prokinetic in critically ill hospitalised patients.
Material and Methods Retrospective observational study in critically ill patients over a period of 12 months (04/2021-03/2022). Patient data were obtained using Farmasyst® and Orion Clinic® software: sex, age, weight, start and end date of treatment, dosage, clinical service, diagnosis, concomitant prokinetics (metoclopramide, dexpanthenol) and clinical course. The efficacy of erythromycin use was assessed by the absence of symptoms such as abdominal distension, flatus and hydro aerial sounds or nausea.
Results 39 patients were studied, 64% were men and 36% women, with a mean age of 64 years and an average weight of 71 kilograms. 85% were in surgical intensive care unit, the rest in intensive care unit. All patients were prescribed erythromycin at doses of 250 milligrams every 8 hours, maintaining treatment for an average of 5 days. The diagnoses for which erythromycin was prescribed were: weak peristalsis in 13 patients, absent peristalsis in 18, intolerance to enteral nutrition in 6 patients, and upper gastrointestinal bleeding in 2. On the other hand, 39% of all patients had already been prescribed 10 mg of intravenous metoclopramide every 8 hours as a prokinetic prior to starting erythromycin, and this was maintained when treatment with the macrolide was initiated. In 41.5% of patients, metoclopramide was prescribed together with erythromycin. Erythromycin treatment was ending in 37 patients due to clinical improvement with resolution of abdominal distension, auscultation of peristalsis and presence of stool, in 1 patient due to tolerance to enteral nutrition and 1 patient died.
Conclusion and Relevance The use of erythromycin as a prokinetic in the population evaluated has been shown to be effective in improving intestinal motility. There was no difference between groups which were administered metoclopramide or not before or during the treatment with erythromycin. Given the variability observed, in terms of duration, concomitant prokinetics or indication, there is a need to establish a protocol for the use of erythromycin as a prokinetic.
Conflict of Interest No conflict of interest
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