Advice
Intervention and alternatives
Erythromycin is a macrolide antibiotic that is used to treat and prevent infections. It is effective for treating certain infections of the upper and lower respiratory tract, ear, eye, oral cavity, skin and soft tissue, gastrointestinal tract and genitourinary tract, and for treating osteomyelitis. It is also used for prophylaxis in pre- and post-operative trauma, burns and rheumatic fever.
Erythromycin is available in various oral formulations including tablets, capsules and oral suspension at strengths of 125 mg (oral suspensions only), 250 mg and 500 mg. Erythromycin tablets and capsules are enteric coated; erythromycin stearate tablets (Erythrocin 250 and 500) and erythromycin ethylsuccinate tablets (Erythroped A 500) and suspension are less susceptible to the adverse effect of gastric acid. The usual dose in adults is 1−2 g daily in divided doses, with up to 4 g daily taken in severe infections.
Condition
A practice guideline published in The American Journal of Gastroenterology, Clinical guideline: management of gastroparesis, defines gastroparesis as a syndrome of objectively measured delayed gastric emptying in the absence of mechanical obstruction, with key symptoms of early satiety, postprandial fullness, nausea, vomiting, bloating and upper abdominal pain. The majority of cases are idiopathic (36%), due to diabetes (29%) or post-surgical (13%).
Alternative treatment options
The management of gastroparesis centres on nutrition and fluid balance. For pharmacological management, the Clinical guideline: management of gastroparesis and the NICE clinical guideline on type 2 diabetes – newer agents recommend that metoclopramide, domperidone or erythromycin may be considered as motility agents. The NICE clinical guideline on nutrition support in adults advises that metoclopramide or erythromycin may be considered in intensive or acute care settings. Other management approaches include the procedure gastroelectrical stimulation for gastroparesis, guidance on which is currently being updated by the NICE interventional procedures team.
The British National Formulary currently states that metoclopramide and domperidone may be used for treating gastroparesis in people with diabetic neuropathy, and that in rare cases when these anti-emetics are not beneficial, erythromycin (especially intravenous) may be useful. The BNF does not state that that use of erythromycin for this indication is off label.