title: Azithromycin for the treatment of gastroparesis.
abstract: OBJECTIVE
  To evaluate the use of azithromycin for the treatment of gastroparesis.
  
  
  METHODS
  Literature was accessed through PubMed/MEDLINE and Web of Science (both 1966-October 2012) using the terms gastroparesis, diabetic gastroparesis, and azithromycin. Literature was limited to English-language publications. In addition, references from publications identified were reviewed.
  
  
  METHODS
  All articles published in English identified from the data sources were evaluated.
  
  
  RESULTS
  The treatment of gastroparesis depends on the severity of the symptoms, but generally includes dietary modifications, prokinetic medications, and antiemetics. The initial treatment for gastroparesis is a prokinetic agent, and because erythromycin has the greatest effect on gastric emptying, it is often used. Limitations to erythromycin include adverse reactions (nausea, vomiting, and abdominal pain), QTc interval prolongation, CYP3A-associated drug interactions, and tachyphylaxis. Azithromycin, another macrolide, has been shown to increase gastrointestinal motility and may have fewer limitations to its use. Azithromycin has fewer drug interactions, less incidence of QTc interval prolongation, a longer half-life, and fewer gastrointestinal adverse effects. Use of azithromycin may be beneficial in patients with gastric and small bowel dysmotility. Two observational studies have supported its use in gastroparesis, but there have been no controlled studies. All studies published have been performed during testing procedures for gastroparesis; thus, longer-term treatment effects and symptom control need to be studied. There is one ongoing prospective controlled trial with preliminary data available only in abstract form.
  
  
  CONCLUSIONS
  Azithromycin may prove to be an alternative prokinetic agent in gastroparesis, but further study is needed before it can be recommended.
authors: Internal Medicine, Virginia Commonwealth University Health System/Medical College of Virginia Hospitals, Richmond, VA, USA. tpotter@mcvh-vcu.edu
authors: Teresa G
authors: TG
authors: Potter
authors: Kenneth R
authors: KR
authors: Snider
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D018589:Gastroparesis / Q000188:drug therapy*; D006801:Humans
chemical_list: D000900:Anti-Bacterial Agents; D005765:Gastrointestinal Agents; D017963:Azithromycin