Azithromycin for the Treatment of Gastroparesis

Potter, Teresa; Snider, Kenneth R

doi:10.1345/aph.1r541

Cited by 45 publications

(32 citation statements)

References 12 publications

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“…GE t 1/2 was comparable between azithromycin (mean GE t 1/2 10.4±7.2 minutes) and erythromycin (mean GE t 1/2 11.9±8.4 minutes; p =0.30). Due to the fewer drug–drug interactions, a lower incidence of QT prolongation, and a longer half-life with azithromycin, it may be a better alternative to erythromycin 70 ; however, concerns about antimicrobial stewardship may limit its long-term use.…”

Section: Prokineticsmentioning

confidence: 99%

Diabetic gastroparesis: current challenges and future prospects

Avalos¹,

Sarosiek²,

Loganathan³

et al. 2018

CEG

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Diabetic gastroparesis (DMGP) is a condition of delayed gastric emptying after gastric outlet obstruction has been excluded. Symptoms of nausea, vomiting, early satiety, bloating, and abdominal pain are associated with DMGP. Uncontrolled symptoms can lead to overall poor quality of life and financial burdens on the healthcare system. A combination of antiemetics and prokinetics is used in symptom control; metoclopramide is the main prokinetic available for clinical use and is the only U.S. Food and Drug Administration-approved agent in the United States. However, a black box warning in 2009 reporting its association with tardive dyskinesia and recommending caution in chronically using this agent beyond 3 months has decreased its role in clinical practice. There is an unmet need for new prokinetics with good efficacy and safety profiles. Currently, there are several new drugs with different mechanisms of action in the pipeline that are under investigation and show promising preliminary results. Surgically combining gastric electrical stimulation with pyloroplasty is considered “gold” standard. Advances in therapeutic endoscopic intervention with gastric per-oral endoscopic pyloromyotomy have also been shown to improve gastric emptying and gastroparesis (GP) symptoms. In this review, we will comment on the challenges encountered when managing patients with DMGP and provide an update on advances in drug development and endoscopic and surgical interventions.

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Section: Prokineticsmentioning

confidence: 99%

Diabetic gastroparesis: current challenges and future prospects

Avalos¹,

Sarosiek²,

Loganathan³

et al. 2018

CEG

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show abstract

“…Azithromycin has been suggested as an alternative to erythromycin for use as a prokinetic. It has a longer half-life and fewer side effects although currently there is limited evidence to support its use this way 5. Further work over its role in comparison with erythromycin would be of value.…”

Section: Resultsmentioning

confidence: 99%

Erythromycin: prophylaxis against recurrent small bowel obstruction

Rea¹,

Husbands

2017

BMJ Support Palliat Care

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We describe three cases where erythromycin suspension has been used successfully in preventing recurrence of small bowel obstruction in patients with terminal illness and for whom it proved more effective than standard preparations such as metoclopramide and domperidone. These patients also experienced a longer term benefit over some months. With recent alerts over longer term use of metoclopramide and domperidone, we demonstrate that erythromycin is a viable alternative prokinetic in patients with terminal illness at risk of small bowel obstruction instead of or alongside metoclopramide and domperidone. More research is required to establish the point at which erythromycin should be considered in the management of symptoms. In addition, research into the possibility of a viable alternative to erythromycin is needed.

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“…Azithromycin is another macrolide antibiotic that is currently being studied for its prokinetic properties. In manometric human and animal studies comparing azithromycin and erythromycin as prokinetic agents, azithromycin was found to be at least as potent as erythromycin in stimulating antral contractility . Azithromycin may, therefore, provide an alternative to erythromycin for gastroprokinetic applications.…”

Section: Specific Pharmacological Interventionsmentioning

confidence: 99%

Gastrointestinal dysmotility disorders in critically ill dogs and cats

Whitehead

Cortes

Eirmann

2016

J Vet Emergen Crit Care

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Objective -To review the human and veterinary literature regarding gastrointestinal (GI) dysmotility disorders in respect to pathogenesis, patient risk factors, and treatment options in critically ill dogs and cats. Etiology -GI dysmotility is a common sequela of critical illness in people and small animals. The most common GI motility disorders in critically ill people and small animals include esophageal dysmotility, delayed gastric emptying, functional intestinal obstruction (ie, ileus), and colonic motility abnormalities. Medical conditions associated with the highest risk of GI dysmotility include mechanical ventilation, sepsis, shock, trauma, systemic inflammatory response syndrome, and multiple organ failure. The incidence and pathophysiology of GI dysmotility in critically ill small animals is incompletely understood. Diagnosis -A presumptive diagnosis of GI dysmotility is often made in high-risk patient populations following detection of persistent regurgitation, vomiting, lack of tolerance of enteral nutrition, abdominal pain, and constipation. Definitive diagnosis is established via radioscintigraphy; however, this diagnostic tool is not readily available and is difficult to perform on small animals. Other diagnostic modalities that have been evaluated include abdominal ultrasonography, radiographic contrast, and tracer studies. Therapy -Therapy is centered at optimizing GI perfusion, enhancement of GI motility, and early enteral nutrition. Pharmacological interventions are instituted to promote gastric emptying and effective intestinal motility and prevention of complications. Promotility agents, including ranitidine/nizatidine, metoclopramide, erythromycin, and cisapride are the mainstays of therapy in small animals. Prognosis -The development of complications related to GI dysmotility (eg, gastroesophageal reflux and aspiration) have been associated with increased mortality risk. Institution of prophylaxic therapy is recommended in high-risk patients, however, no consensus exists regarding optimal timing of initiating prophylaxic measures, preference of treatment, or duration of therapy. The prognosis for affected small animal patients remains unknown. (J Vet Emerg

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Azithromycin for the Treatment of Gastroparesis

Abstract: Azithromycin may prove to be an alternative prokinetic agent in gastroparesis, but further study is needed before it can be recommended.

Cited by 45 publications

References 12 publications

Diabetic gastroparesis: current challenges and future prospects

Diabetic gastroparesis: current challenges and future prospects

Erythromycin: prophylaxis against recurrent small bowel obstruction

Gastrointestinal dysmotility disorders in critically ill dogs and cats

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