Related Experiment Videos

Erythromycin for prokinesis: imprudent prescribing?

Martino Dall'Antonia1, Mark Wilks, Pietro G Coen

  • 1Queen Elizabeth Hospital NHS Trust, Stadium Road, Woolwich, London SE18 4QH, UK. mdallantonia@nhs.net

Critical Care (London, England)
|January 20, 2006
PubMed

Insights

Using erythromycin for gastrointestinal motility in intensive care units (ICUs) is concerning. This practice may increase antibiotic resistance and Clostridium difficile infections, urging the use of alternative prokinetic agents.

Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Pharmacology

Background:

  • Antibiotic-resistant bacteria, including Methicillin-resistant Staphylococcus aureus (MRSA), Acinetobacter baumanii, and extended-spectrum beta-lactamase (ESBL) producing gram-negative bacilli, pose significant challenges in hospital settings, especially in intensive care units (ICUs).
  • Early enteral feeding is associated with improved survival rates in ICU patients.
  • Prokinetic agents are commonly administered to manage gastrointestinal dysmotility in critically ill patients.

Purpose of the Study:

  • To evaluate the implications of using sub-therapeutic doses of erythromycin as a prokinetic agent in ICU patients.
  • To highlight the potential risks associated with this practice, specifically concerning the development and spread of antibiotic resistance and Clostridium difficile infections.

Main Methods:

  • This study is a review and critical analysis of current clinical practices regarding the use of erythromycin as a prokinetic agent in ICUs.
  • Literature review on the impact of sub-therapeutic antibiotic use on antimicrobial resistance and C. difficile infections.

Main Results:

  • The use of erythromycin at sub-therapeutic doses as a prokinetic agent is linked to an increased emergence and spread of antibiotic resistance.
  • This practice also elevates the risk of Clostridium difficile-associated diseases.
  • The administration of antibiotics for non-antimicrobial purposes, such as prokinetic effects, is not considered prudent antimicrobial prescribing.

Conclusions:

  • The use of erythromycin as a prokinetic agent in ICUs is strongly discouraged due to the significant risks of promoting antibiotic resistance and C. difficile infections.
  • Alternative prokinetic agents should be prioritized whenever feasible to ensure appropriate antimicrobial stewardship.
  • Avoiding the off-label use of antibiotics for non-antimicrobial indications is crucial for infection control and patient safety in critical care settings.

Related Concept Videos

Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
Drugs Affecting GI Tract Motility: Dopamine Receptor Antagonists01:28

Drugs Affecting GI Tract Motility: Dopamine Receptor Antagonists

Prokinetic agents are specialized medications that stimulate gastrointestinal (GI) motility, promoting food movement through the GI tract. Dopamine, an inhibitory neurotransmitter, plays a significant role in this process, reducing GI motility and indirectly controlling the speed of digestion. Dopamine receptor antagonists, such as metoclopramide and domperidone, offer a unique advantage as prokinetic agents. By blocking the dopamine receptors, these drugs increase GI motility, improving food...
Antiepileptic Drugs: Potassium Channel Activators01:20

Antiepileptic Drugs: Potassium Channel Activators

Ezocgabine or retigabine, an antiepileptic drug of remarkable efficacy, has revolutionized the management of seizures. It is a potassium channel activator, explicitly targeting the family of Q subtype potassium channels. It enhances the transmembrane potassium currents, regulating neuronal excitability. This action stabilizes the resting membrane potential, a pivotal factor in mitigating the hyperexcitability that characterizes epilepsy.
Ezogabine has gained approval as an adjunctive treatment...
Drug Dosing: Geriatric Patients01:15

Drug Dosing: Geriatric Patients

Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment01:08

Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment

Hepatic impairment, characterized by decreased liver function, does not uniformly mandate adjustments in drug dosage. Whether dosage modifications are necessary depends on various factors related to the drug's metabolism and elimination pathways. If a drug is primarily excreted via the kidneys and bypasses significant hepatic processing, if it undergoes minimal metabolic transformation in the liver, or if it is volatile and primarily expelled through the lungs, dose adjustments may not be...
Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...