Erythromycin dose of 70 mg accelerates gastric emptying as effectively as 200 mg in the critically ill

Objective: To compare the effectiveness of 70-mg and 200-mg doses of intravenous erythromycin in improving gastric emptying in critically ill patients. Design: Gastric emptying was measured on consecutive days; day 1 (pre-treatment), day 2 (post-treatment) after an intravenous 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 intravenously over 20 min. Measurements and results: Gastric emptying was measured using the [C-13]octanoic acid breath test. The gastric emptying coefficient (GEC) and half-emptying time (t(1/2)) were calculated from the area under the <(CO2)-C-13-recovery curve. Pre-treatment gastric emptying measurements were similar in all three patient groups. Treatment with both doses of erythromycin significantly reduced the gastric t(1/2): 70 mg, 98 min (IQR 88-112); 200 mg, 86 min (75-104); vs. placebo, 122 min (102-190) (p < 0.05). 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 < 0.05). There was no difference in gastric emptying post-treatment between the two doses of erythromycin. The effect of erythromycin was greatest in patients with delayed gastric emptying. Conclusions: Treatment with 70 and 200 mg intravenous erythromycin are equally effective in accelerating gastric emptying in the critically ill.