Randomized double-blind crossover study to determine the effects of erythromycin
on small intestinal nutrient absorption and transit in the critically ill.
Author(s): Deane AM, Wong GL, Horowitz M, Zaknic AV, Summers MJ, Di Bartolomeo AE, Sim JA,
Maddox AF, Bellon MS, Rayner CK, Chapman MJ, Fraser RJ.
Affiliation(s): Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia.
adam.deane@adelaide.edu.au
Publication date & source: 2012, Am J Clin Nutr. , 95(6):1396-402
BACKGROUND: The gastrokinetic drug erythromycin is commonly administered to
critically ill patients during intragastric feeding to augment small intestinal
nutrient delivery. However, erythromycin has been reported to increase the
prevalence of diarrhea, which may reflect reduced absorption and/or accelerated
small intestinal transit.
OBJECTIVE: The objective was to evaluate the effects of intravenous erythromycin
on small intestinal nutrient absorption and transit in the critically ill.
DESIGN: On consecutive days, erythromycin (200 mg in 20 mL 0.9% saline) or
placebo (20 mL 0.9% saline) were infused intravenously between -20 and 0 min in a
randomized, blinded, crossover fashion. Between 0 and 30 min, a liquid nutrient
containing 3-O-methylglucose (3-OMG), [13C]triolein, and [(99m)Tc]sulfur colloid
was administered directly into the small intestine at 2 kcal/min. Serum 3-OMG
concentrations and exhaled (13)CO2 (indices of glucose and lipid absorption,
respectively) were measured. Cecal arrival of the infused nutrient was determined
by scintigraphy. Data are medians (ranges) and were analyzed by using Wilcoxon's
signed-rank test.
RESULTS: Thirty-two mechanically ventilated patients were studied. Erythromycin
increased small intestinal glucose absorption [3-OMG AUC360: 105.2 (28.9-157.0)
for erythromycin compared with 91.8 (51.4-147.9) mmol/L ยท min for placebo; P =
0.029] but tended to reduce lipid absorption [cumulative percentage dose (13)CO2
recovered: 10.4 (0-90.6) compared with 22.6 (0-100) %; P = 0.06]. A trend to
slower transit was observed after erythromycin [300 (39-360) compared with 228
(33-360) min; P = 0.07].
CONCLUSIONS: Acute administration of erythromycin increases small intestinal
glucose absorption in the critically ill, but there was a tendency for the drug
to reduce small intestinal lipid absorption and slow transit. These observations
have implications for the use of erythromycin as a gastrokinetic drug in the
critically ill. This trial was registered in the Australian New Zealand Clinical
Trials Registry as ACTRN 12610000615088.
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