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Sub-antibiotic doses of erythromycin as a prokinetic in abdominal surgeries: reviving the old.

Author(s): Omar SH, Kamel NM, Radwan KG, Ebied RS, Ali MZ, Osman ES, Kamel HH

Affiliation(s): Department of Anesthesia, Theodor Bilharz Research Institute, Embaba 30, Giza, Egypt.

Publication date & source: 2010-12, J Egypt Soc Parasitol., 40(3):809-20.

Publication type: Randomized Controlled Trial

All patients undergoing major abdominal procedures have some degree of gastricatony in the immediate postoperative period, presenting mainly with vomiting. Many prokinetic agents have been used in the past, but none is a universal remedy. Studies showed that subantibiotic doses of erythromycin, a macrolide antibiotic and motilin agonist, accelerates gastric emptying. This study investigated whether preoperative subantibiotic dose oral erythromycin (250 mg), altered residual gastric volume and postoperative adverse effects in patients scheduled for abdominal surgeries. Erythromycin was compared with the commonly used prokinetic metoclopramide and antiemetic ondansetron, in terms of prokinetic efficacy, cost and adverse effects. In a double-blind study, eighty patients (20 each) were allocated randomly to receive orally, either erythromycin 250 mg (E250) or erythromycin 500 mg (E500), or 10 mg metoclopramide (M), or 4 mg ondansetron (Z), an hour pre-induction of anesthesia. Preoperative oral erythromycin in subantibiotic dose 250 mg elicited a significntly lower residual gastric volume (P < 0.001) and a lower VAS for vomiting, compared with ondansetron. As for metoclopramide and erythromycin 500, residual gastric volume was comparable, but E 250 had a lower VAS for vomiting than both groups. Rescue remedy for vomiting was required for groups E500, M and Z (100, 10 and 10%) compared to 0% in group E250. Ultimately, subantibiotic oral dose of erythromycin (250 mg), given 1 hr preoperatively, is an inexpensive prokinetic alternative with a promising post-operative profile which may be superior to the inexpensive prokinetic metoclopramide with known adverse effects, and the expensive antiemetic ondansetron.

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