Randomized double-blind crossover study to determine the effects of erythromycin on small intestinal nutrient absorption and transit in the critically ill

Adam Deane, Gerald Wong, Michael Horowitz, Antony Zaknic, Matthew Summers, Anna Di Bartolomeo, Jennifer Sim, Anne Maddox, Max Bellon, Christopher Rayner, Marianne Chapman, Robert Fraser

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    Abstract

    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 220 and 0 min in a randomized, blinded, crossover fashion. Between 0 and 30 min, a liquid nutrient containing 3-Omethylglucose (3-OMG), [ 13C]triolein, and [99mTc]sulfur colloid was administered directly into the small intestine at 2 kcal/min. Serum 3-OMG concentrations and exhaled 13CO2 (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 · min for placebo; P = 0.029] but tended to reduce lipid absorption [cumulative percentage dose 13CO2 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.

    Original languageEnglish
    Pages (from-to)1396-1402
    Number of pages7
    JournalAmerican Journal of Clinical Nutrition
    Volume95
    Issue number6
    DOIs
    Publication statusPublished - 2012

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    Deane, A., Wong, G., Horowitz, M., Zaknic, A., Summers, M., Di Bartolomeo, A., Sim, J., Maddox, A., Bellon, M., Rayner, C., Chapman, M., & Fraser, R. (2012). Randomized double-blind crossover study to determine the effects of erythromycin on small intestinal nutrient absorption and transit in the critically ill. American Journal of Clinical Nutrition, 95(6), 1396-1402. https://doi.org/10.3945/ajcn.112.035691