Treatment Of Postoperative Ileus After Bowel Surgery With Low-Dose Intravenous Erythromycin

Main Category: GastroIntestinal / Gastroenterology
Also Included In: Clinical Trials / Drug Trials
Article Date: 11 Jun 2007 - 0:00 PDT


UroToday.com- Postoperative ileus is a normal, transient, physiologic response after abdominal surgery thought to be caused by an activation of inhibitory neural reflexes, increased release of inhibitory neurotransmitters in the gut, and increased inflammation secondary to edema. The ileus can lead to increased morbidity, length of hospital stay, and health care costs.

Recently, a report by A. Lightfoot and colleagues from the University of Iowa evaluated the use of low-dose intravenous erythromycin for the treatment of post-operative ileus. The study is published in the April 2007 issue of Urology.

Erythromycin (EM) is a macrolide antibiotic that at low doses acts as a prokinetic agent by binding directly to motilin receptors on the smooth muscle cells within the gastrointestinal tract. Once bound, erythromycin, like motilin induces phase 3-like contractile activity of the migrating motor complexes. At high doses, erythromycin can cause spastic contraction of the stomach as well as moderate inhibition of small bowel motor activity. This explains some of the untoward side effects of the drug.

A randomized, double-blind, clinical trial of low-dose erythromycin was performed on 22 volunteers undergoing cystectomy and diversion. On the first post-operative day, patients began receiving intravenous erythromycin (125 mg) or placebo every 8 hours (maximum of 21 doses). The patients' ability to tolerate a general diet and return of bowel function was monitored.

Analysis of the results showed that a house diet was tolerated at a median of 9 days postoperatively for the erythromycin group and 8 days for the placebo arm (P = 0.60. The first bowel sounds were detected at an average of 2 postoperative days in the EM arm and 3 for the placebo arm. (P = 0.88). First flatus was present an average of 5 days postoperatively for both study arms. The first bowel movement was present an average of 6 days postoperatively for the EM arm and 5 for the placebo arm (P = 0.98).

In conclusion, no significant difference was found between erythromycin and placebo with regards to the onset of bowel sounds, flatus, passage of the first bowel movement, and the time to tolerate a general diet in this small but well designed study. This data indicates that erythromycin is not useful in improving postoperative bowel function.

Lightfoot AJ, Eno M, Kreder KJ, O'Donnell MA, Rao SSC, Williams RD

Urology. 69(4):611-15, April 2007.
doi:10.1016/j.urology.2006.12.027

Reported by UroToday.com Contributing Editor Michael J. Metro, M.D.

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