Azithromycin versus erythromycin infusions prior to endoscopy in upper gastrointestinal bleeding

Area of Science:

• Gastroenterology
• Pharmacology

Background:

• Erythromycin infusion before endoscopy improves outcomes for upper gastrointestinal bleeding (GIB).
• Erythromycin requires extensive preparation, delaying emergency administration.
• Azithromycin is readily available and requires minimal preparation.

Purpose of the Study:

• To compare the efficacy of azithromycin versus erythromycin in improving endoscopic visualization quality for upper GIB.

Main Methods:

• A comparative study included 66 patients with upper GIB receiving either azithromycin or erythromycin before urgent endoscopy.
• Endoscopic visualization quality was assessed by two blinded gastroenterologists using a standardized scoring system (0-8).
• Primary outcome was the visualization score; secondary outcomes included length of stay (LOS) and procedure-related complications.

Main Results:

• Azithromycin resulted in significantly higher mean visualization scores (6.8±1.4) compared to erythromycin (5.5±2.2; P=0.01).
• Patients receiving azithromycin had a shorter LOS (6 days) versus erythromycin (8 days; P=0.04).
• Infusion-to-endoscopy time was longer with azithromycin (40.64 min; P=0.02), with no significant differences in other outcomes.

Conclusions:

• Azithromycin infusion before endoscopy for upper GIB is associated with superior visualization quality compared to erythromycin.
• Azithromycin may be a more practical alternative in emergency GIB settings due to faster preparation.
• Further randomized trials are recommended to confirm these findings.