Gastrointestinal side effects after intravenous erythromycin lactobionate.

Abstract

Ten healthy normal volunteers received an intravenous infusion of erythromycin lactobionate over 60 min to a total dose of 800 mg (n = 9), and 524 mg (n = 1). Blood samples were collected at 10 min intervals for 100 min and gastric contents aspirated, via a nasogastric tube, from pre‐dose to 105 min after start of infusion. Incidence and severity of three gastrointestinal symptoms (nausea, stomach discomfort and feelings of hunger), two CNS symptoms (dizziness and faintness) and a 'control' symptom (back pain) were measured using 100 mm visual analogue scales. Rate of infusion and plasma erythromycin concentration correlated with nausea (P less than 0.001) and stomach discomfort (P less than 0.001); plasma erythromycin concentration was also correlated with dizziness (P less than 0.05). Concentrations of active erythromycin in the aspirate were pH dependent. In one subject the concentration of erythromycin in the aspirate exceeded that in the plasma by 100 fold. Bile staining of samples containing the highest levels of microbiologically active erythromycin makes the origin of the erythromycin in these samples uncertain.

Pre-operative oral erythromycin reduces residual gastric volume and acidity

“…It has been shown that there is a signi®cant correlation between severity of symptoms and infusion rate or between symptoms and plasma erythromycin concentration. 5…”

Effects of cholinoceptor and 5‐hydroxytryptamine3 receptor antagonism on erythromycin‐induced canine intestinal motility disruption and emesis

“…These studies were prompted by numerous reports associating cramping, nausea, vomiting and diarrhoea with erythromycin treatment, which in some cases were severe enough to discontinue treatment (Shoemaker & Yow, 1954;Mather et al, 1981;Downey & Chaput de Saintonge, 1986;Hovi et al, 1987;Shanks et al, 1989). Erythromycin was found to have a disruptive effect on gastrointestinal motor patterns (Pilot et al, 1984;Itoh et al, 1984), even when administered at very low, subtherapeutic doses (Tomomasa et al, 1986;Otterson & Sarna, 1990).…”

Effect of Preoperative Oral Use of Erythromycin and Nizatidine on Gastric pH and Volume

“…Erythromycin is a macrolide antibiotic with a side-effect of strong gastric contractions at therapeutic dosages of 500-1000 mg. At a low dosage of 200 mg, it causes intermittent gastric contractions which spread to the small intestine [6][7][8] . It has been demonstrated in healthy volunteers that erythromycin at low doses increases gastric emptying 9 .…”