title: Randomized double-blind crossover study to determine the effects of erythromycin on small intestinal nutrient absorption and transit in the critically ill.
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.
  
  
  METHODS
  On consecutive days, erythromycin (200 mg in 20 mL 0.9% saline) or placebo (20 mL 0.9% saline) were infused intravenously between -20 and 0 min in a randomized, blinded, crossover fashion. Between 0 and 30 min, a liquid nutrient containing 3-O-methylglucose (3-OMG), [13C]triolein, and [(99m)Tc]sulfur colloid was administered directly into the small intestine at 2 kcal/min. Serum 3-OMG concentrations and exhaled (13)CO2 (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 (13)CO2 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.
authors.affiliation: Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia. adam.deane@adelaide.edu.au
authors.forename: Adam M
authors.initials: AM
authors.lastname: Deane
authors.forename: Gerald L
authors.initials: GL
authors.lastname: Wong
authors.forename: Michael
authors.initials: M
authors.lastname: Horowitz
authors.forename: Antony V
authors.initials: AV
authors.lastname: Zaknic
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Summers
authors.forename: Anna E
authors.initials: AE
authors.lastname: Di Bartolomeo
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Sim
authors.forename: Anne F
authors.initials: AF
authors.lastname: Maddox
authors.forename: Max S
authors.initials: MS
authors.lastname: Bellon
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Rayner
authors.forename: Marianne J
authors.initials: MJ
authors.lastname: Chapman
authors.forename: Robert Jl
authors.initials: RJ
authors.lastname: Fraser
mesh_terms: D000328:Adult; D000368:Aged; D050260:Carbohydrate Metabolism / Q000187:drug effects; D002245:Carbon Dioxide / Q000378:metabolism; D002432:Cecum / Q000378:metabolism; D016638:Critical Illness / Q000628:therapy*; D018592:Cross-Over Studies; D003967:Diarrhea / Q000139:chemically induced; D004311:Double-Blind Method; D004750:Enteral Nutrition / Q000379:methods; D004917:Erythromycin / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D005772:Gastrointestinal Transit / Q000187:drug effects*; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D007262:Infusions, Intravenous; D007408:Intestinal Absorption / Q000187:drug effects; D007421:Intestine, Small / Q000187:drug effects* / Q000378:metabolism; D050356:Lipid Metabolism / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009748:Nutrition Disorders / Q000378:metabolism / Q000517:prevention & control*; D012121:Respiration, Artificial; D013455:Sulfur / Q000378:metabolism; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents; D002245:Carbon Dioxide; D004917:Erythromycin; D013455:Sulfur; D005947:Glucose