Erythromycin Dose of 70 mg Accelerates Gastric Emptying as Effectively as 200 mg in the Critically Ill

Abstract

Objective: To compare the effectiveness of 70-mg and 200-mg doses of IV erythromycin in improving gastric emptying in critically ill patients. Design: Gastric emptying was measured on consecutive days; day 1 (pretreatment), day 2 (posttreatment) after an IV 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 IV 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 (t_½) were calculated from the area under the ¹³CO₂-recovery curve. Pretreatment gastric emptying measurements were similar in all 3 patient groups. Treatment with both doses of erythromycin significantly reduced the gastric t_½: 70 mg, 98 min (IQR 88–112); 200 mg, 86 min (75–104); vs placebo, 122 min (102–190) (p < .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 < .05). There was no difference in gastric emptying posttreatment between the 2 doses of erythromycin. The effect of erythromycin was greatest in patients with delayed gastric emptying. Conclusions: Treatment with 70 and 200 mg IV erythromycin is equally effective in accelerating gastric emptying in the critically ill.