From the Guidelines
Erythromycin should be considered before emergency endoscopy for GI bleed at a dose of 250 mg i.v., 30–120 min before, to facilitate the procedure by improving visibility, in the absence of contraindications such as QT prolongation. When managing GI bleeding, particularly in patients with cirrhosis, it is crucial to prioritize a comprehensive approach that includes resuscitation, blood product administration, and definitive endoscopic therapy 1. The use of erythromycin as a motilin receptor agonist can enhance gastric emptying, thereby improving visualization during endoscopy by clearing blood and clots from the stomach, which is beneficial for identifying bleeding sources and performing therapeutic interventions more effectively 1. Key considerations for the use of erythromycin include monitoring for QT prolongation, especially in patients with cardiac conditions or those taking other QT-prolonging medications, and using caution in patients with liver disease, myasthenia gravis, or a history of allergic reactions to macrolide antibiotics. In the context of acute variceal hemorrhage (AVH), the combination of endoscopic therapy and vasoactive drugs is considered the standard of care, offering a synergistic effect by combining local hemostatic effects on varices with portal hypotensive effects achieved through drug therapy 1. Additionally, prevention of complications such as bacterial infections, hepatic encephalopathy, and deterioration of renal function should be addressed simultaneously with hemostatic therapies, with antibiotic prophylaxis recommended to reduce the incidence of infections and improve outcomes 1.
From the Research
Gi Bleed Erythromycin
- Erythromycin is used as a prokinetic agent in the management of acute upper gastrointestinal bleeding (UGIB) 2, 3.
- The use of erythromycin, in combination with proton pump inhibitors (PPIs), is recommended after resuscitation is initiated in patients with UGIB 2.
- Erythromycin is used to promote gastric emptying and improve visibility during endoscopy, which is typically undertaken within 24 hours of presentation 2, 3.
- The management of UGIB also involves risk stratification, restrictive red blood cell transfusion, and pharmacologic therapy with erythromycin and a PPI, with antibiotics and vasoactive medications recommended in patients with cirrhosis 3.
- The evidence suggests that erythromycin is a useful adjunct in the management of UGIB, particularly in patients who are at high risk of rebleeding or have cirrhosis 2, 3.