title: Gastrointestinal side effects of intravenous erythromycin: incidence and reduction with prolonged infusion time and glycopyrrolate pretreatment.
abstract: OBJECTIVE
  To determine the frequency of gastrointestinal toxicity due to intravenous (IV) erythromycin and to attempt to decrease this toxicity by prolonging the infusion time of erythromycin and/or pretreating with the peripheral anticholinergic, glycopyrrolate 0.1 mg IV.
  
  
  METHODS
  Randomized, double-blind, placebo-controlled trial.
  
  
  METHODS
  General medical wards of a tertiary medical center.
  
  
  METHODS
  A total of 51 hospitalized patients 18 years of age or older who were prescribed IV erythromycin lactobionate (EMLB) 500 mg every 6 hours by their attending physicians.
  
  
  METHODS
  Each of eight consecutive infusions of EMLB was randomly assigned to one of four groups: control--30-minute infusion/placebo pretreatment; 60/P--60-minute infusion/placebo pretreatment; 30/G--30-minute infusion/glycopyrrolate pretreatment; and 60/G--60-minute infusion/glycopyrrolate pretreatment.
  
  
  METHODS
  Each infusion was accompanied by a questionnaire in which patients rated the magnitude of nausea and vomiting on a scale of 1 (no toxicity) to 9 (severe toxicity). Scores for both nausea and vomiting were added together for a total toxicity score ranging from 2 to 18. A total score of greater than 8 was defined as clinically important.
  
  
  RESULTS
  The 51 patients received a total of 356 infusions with gastrointestinal toxicity occurring in 27 of 51 (53%) patients. Among patients under the age of 40, 22 of 33 (67%) experienced toxicity compared with only five of 18 patients (28%) over the age of 40 (p = 0.018). Clinically important toxicity was seen in 19 of 51 patients (37%), including five who withdrew during the study because of severe nausea and vomiting. In this group, the combination of a 60-minute erythromycin infusion and glycopyrrolate pretreatment decreased clinically important toxicity by 79% from 47% to 10%, a statistically and clinically significant 37% (95% CI, 14% to 60%) difference (p = 0.007).
  
  
  CONCLUSIONS
  Gastrointestinal toxicity associated with the IV infusion of erythromycin is common and is more likely to occur in younger patients. A 1-hour infusion of erythromycin combined with pretreatment with glycopyrrolate, 0.1 mg IV, is effective in reducing this toxicity.
authors.affiliation: Department of Internal Medicine, Naval Hospital, San Diego, California 92134-5000.
authors.forename: W A
authors.initials: WA
authors.lastname: Bowler
authors.forename: C
authors.initials: C
authors.lastname: Hostettler
authors.forename: D
authors.initials: D
authors.lastname: Samuelson
authors.forename: B S
authors.initials: BS
authors.lastname: Lavin
authors.forename: E C
authors.initials: EC
authors.lastname: Oldfield
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D004917:Erythromycin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D006024:Glycopyrrolate / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006772:Hospitals, Military; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology; D011292:Premedication; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D014839:Vomiting / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology
chemical_list: C010948:erythromycin lactobionate; D004917:Erythromycin; D006024:Glycopyrrolate