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Erythromycin vs Metoclopramide for Facilitating Gastric Emptying and Tolerance to Intragastric Nutrition in Critically Ill Patients
Author(s) -
MacLaren Robert,
Kiser Tyree H.,
Fish Douglas N.,
Wischmeyer Paul E.
Publication year - 2008
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607108319803
Subject(s) - metoclopramide , cmax , gastric emptying , medicine , erythromycin , pharmacokinetics , acetaminophen , ranitidine , gastroenterology , anesthesia , stomach , chemistry , antibiotics , vomiting , biochemistry
Background: The purpose of this study is to evaluate erythromycin vs metoclopramide for facilitating gastric emptying and tolerance to intragastric enteral nutrition (EN). Methods: Twenty critically ill patients with a gastric residual >150 mL while receiving EN were randomized to receive 4 intravenous doses of erythromycin 250 mg or metoclopramide 10 mg, each administered every 6 hours. Acetaminophen 975 mg was administered enterally at baseline and after the fourth dose. Acetaminophen peak plasma concentration (Cmax), concentration at 60 minutes (C 60 ), time to Cmax (Tmax), and area under the concentration‐time curve from 0 to 60 minutes (AUC 0‐60 ) were determined. Residual volumes and feeding rates were recorded. Results: Compared with baseline, erythromycin increased Cmax (9.5 ± 6.1 mg/L to 17.7 ± 11.9 mg/L, P < .01), C 60 (5.4 ± 3.5 mg/L to 12.9 ± 7.6 mg/L, P < .01), and AUC 0‐60 (3.5 ± 3.0 mg·h/L to 12.5± 8.7 mg·h/L, P < .01), while metoclopramide increased only AUC 0‐60 (4.4 ± 2.8 mg·h/L to 9.5± 3.8 mg·hr/L, P < .05). Neither agent significantly reduced Tmax. Both erythromycin and metoclopramide reduced residual volumes (122 ± 48 mL to 36 ± 48 mL, P < .01, and 103± 88 mL to 21 ± 23 mL, P < .05, respectively) and allowed increased feeding rates (17 ± 23 mL/h to 45 ± 21 mL/h, P < .05, and 14 ± 17 mL/h to 44 ± 22 mL/h, P < .05, respectively). Conclusions: Both agents facilitate tolerance to intragastric EN, but erythromycin may be more effective than metoclopramide for enhancing gastric motility.