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. 2016 Jul-Sep;10(3):308-13.
doi: 10.4103/1658-354X.174902.

Comparison of erythromycin versus metoclopramide for gastric feeding intolerance in patients with traumatic brain injury: A randomized double-blind study

Jeetinder Kaur Makkar  1 , Basanta Gauli  1 , Kajal Jain  1 , Divya Jain  1 , Yatinder Kumar Batra  1
Affiliations

Comparison of erythromycin versus metoclopramide for gastric feeding intolerance in patients with traumatic brain injury: A randomized double-blind study

Jeetinder Kaur Makkar et al. Saudi J Anaesth. 2016 Jul-Sep.

Abstract

Background: No randomized controlled trial demonstrates the efficacy of erythromycin or metoclopramide in patients with traumatic brain injury (TBI). This study was conducted to determine the efficacy of metoclopramide and erythromycin for improving gastric aspirate volume (GAV) in patients with TBI.

Materials and methods: Patients with Glasgow coma score more than 5 admitted to trauma Intensive Care Unit within 72 h of head injury were assessed for eligibility. 115 patients were prospectively randomized to receive metoclopramide, erythromycin, or placebo eighth hourly. Gastric feeding intolerance was defined as GAV more than 150 ml with abdominal symptoms. Two consecutive high GAV was defined as feeding failure. Feeding failure was treated by increasing the frequency of dose to 6 hourly in metoclopramide and erythromycin group. Combination therapy with both drugs was given as rescue in the placebo group.

Results: Incidence of high GAV was as high as 60.5% in placebo group. Use of erythromycin was associated with a decrease in the incidence of feeding intolerance to 28.9% (P = 0.006). Although feed intolerance decreased to 43.6% in metoclopramide group, values did not reach statistical significance. The proportion of patients not having high GAV at different days were significantly higher in erythromycin group (P = 0.027, log-rank test). There was no difference in the proportion of patients not having feeding failure in three groups with increasing number of days.

Conclusion: There was a significant decrease in the incidence of high GAV with the use of erythromycin when compared to metoclopramide and placebo.

Keywords: Erythromycin; gastric feeding intolerance; traumatic brain injury.

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Figures

Figure 1
Figure 1
Flow diagram showing feeding protocol
Figure 2
Figure 2
Study flow diagram
Figure 3
Figure 3
Kaplan-Meier analysis curve showing proportion of patients having high gastric aspirate volume. A significant difference in proportion of patients not having high gastric aspirate volume at different days was found with group erythromycin (P= 0.027, log-rank test)
Figure 4
Figure 4
Kaplan-Meier analysis curve showing proportion of patients having feeding failure. No significant difference was found in proportion of patients not having feeding failure between the three group with increasing number of days
See this image and copyright information in PMC

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