title: Erythromycin for prokinesis: imprudent prescribing?
abstract: Problems with antibiotic resistant bacteria are increasing in the hospital and particularly in the intensive care unit. Methicillin-resistant Staphylococcus aureus, Acinetobacter baumanii and extended spectrum beta-lactamase producing gram-negative bacilli constitute a therapeutic and infection control challenge. Early enteral feeding improves survival in patients in the intensive care unit. Prokinetic agents are routinely used in patients with inappropriate gastrointestinal motility. The use of erythromycin at sub-therapeutic doses as a prokinetic agent is a cause of concern for the following reasons: it can increase the emergence and spread of antibiotic resistance and the likelihood of Clostridium difficile disease. The use of an antibiotic as a prokinetic agent does not constitute prudent antimicrobial prescribing and should be avoided. Alternative agents, whenever possible, should be used.
authors.affiliation: Queen Elizabeth Hospital NHS Trust, Stadium Road, Woolwich, London SE18 4QH, UK. mdallantonia@nhs.net
authors.forename: Martino
authors.initials: M
authors.lastname: Dall'Antonia
authors.forename: Mark
authors.initials: M
authors.lastname: Wilks
authors.forename: Pietro G
authors.initials: PG
authors.lastname: Coen
authors.forename: Susan
authors.initials: S
authors.lastname: Bragman
authors.forename: Michael R
authors.initials: MR
authors.lastname: Millar
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000628:therapy*; D003422:Critical Care; D004351:Drug Resistance; D004750:Enteral Nutrition; D004917:Erythromycin / Q000009:adverse effects* / Q000627:therapeutic use*; D005767:Gastrointestinal Diseases / Q000628:therapy; D005769:Gastrointestinal Motility; D006801:Humans; D016106:Methicillin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D004917:Erythromycin