Should neomycin and erythromycin be given at 2am if the patient is NPO?

Administration of Neomycin and Erythromycin During NPO Status

Neomycin and erythromycin scheduled for 2am should be given even if the patient is NPO, as these antibiotics are commonly used for bowel preparation prior to procedures and are intended to be given while the patient is not taking oral food.

Rationale for Administration During NPO Status

• Oral neomycin and erythromycin are frequently used as prophylactic antibiotics for bowel preparation before colorectal surgery and are specifically designed to be given when patients are NPO 1
• These medications are listed in guidelines as "for bowel preparation" with variable dosing, indicating they are meant to be administered during the pre-procedure NPO period 1
• The medications work by reducing intestinal bacterial flora, which is an intended effect during the NPO period before procedures 2

Clinical Evidence Supporting Administration

• Studies show that oral neomycin and erythromycin administration before colorectal procedures significantly reduces postoperative infectious complications compared to placebo (9% vs 43% complication rate) 3
• The medications achieve both intraluminal and systemic levels when administered orally during bowel preparation, with peak serum levels occurring 12-19 hours after initial dosing 4
• The combination of neomycin and erythromycin works through two mechanisms: decreasing colon flora and providing adequate serum antibiotic levels during procedures 2

Important Considerations

• Verify that the neomycin and erythromycin are indeed prescribed for bowel preparation before a procedure, as this is their most common indication when given together 1
• If the patient has swallowing difficulties related to their NPO status (such as in stroke patients), alternative routes of administration should be considered 1
• For patients who are NPO due to stroke, oral medications should not be administered until a swallowing screen has been completed and found normal 1

Administration Protocol

• If the patient is NPO for bowel preparation before a procedure, administer the medications as scheduled at 2am 1
• If the patient is NPO due to swallowing concerns, verify if a swallowing assessment has been completed before administering oral medications 1
• If the patient is NPO for other medical reasons but can safely swallow medications, the antibiotics should still be given as they are designed to work in the intestinal tract 1, 2

Potential Pitfalls

• Do not withhold these medications simply because the patient is NPO for a procedure, as this is precisely when they are intended to be given 1, 3
• Be aware that erythromycin can cause gastrointestinal side effects including epigastric distress, abdominal cramps, nausea, and diarrhea 1
• Verify that the patient doesn't have contraindications to either medication, such as hypersensitivity to macrolide antibiotics for erythromycin 1