OBJECTIVE: To determine the incidence of Clostridium difficile (CD) diarrhoea in feed-intolerant, critically ill patients who received erythromycin-based prokinetic therapy. DESIGN AND SETTING: Prospective observational study in a mixed intensive care unit. METHODS: The development of diarrhoea (> 3 loose, liquid stool per day with an estimated total volume > or = 250ml/day) was assessed in 180 consecutive critically ill patients who received prokinetic therapy (erythromycin only, n = 53; metoclopramide, n 37; combination erythromycin/metoclopramide, n = 90) for feed intolerance. Stool microscopy, culture and CD toxin assay were performed in all patients who developed diarrhoea during and after prokinetic therapy. Diarrhoea was deemed to be related to CD infection if CD toxin was detected. RESULTS: Demographics, antibiotic use and admission diagnosis were similar amongst the three patients groups. Diarrhoea developed in 72 (40%) patients, 9.9 +/- 0.8 days after commencement of therapy, none of whom was positive for CD toxin or bacterial infection. Parasitic infections were found in four aboriginal men from an area endemic for these infections. Diarrhoea was most prevalent in patients who received combination therapy (49%) and was more common than in those who received erythromycin alone (30%) and metoclopramide alone (32%). Diarrhoea was short-lasting with a mean duration of 3.6 +/- 1.2 days. CONCLUSIONS: In critical illness, diarrhoea following the administration of erythromycin at prokinetic doses is not associated with CD but may be related to pro-motility effects of the agent. Prokinetic therapy should be stopped at the onset of diarrhoea and prophylactic use should be strictly avoided.
OBJECTIVE: To determine the incidence of Clostridium difficile (CD) diarrhoea in feed-intolerant, critically ill patients who received erythromycin-based prokinetic therapy. DESIGN AND SETTING: Prospective observational study in a mixed intensive care unit. METHODS: The development of diarrhoea (> 3 loose, liquid stool per day with an estimated total volume > or = 250ml/day) was assessed in 180 consecutive critically ill patients who received prokinetic therapy (erythromycin only, n = 53; metoclopramide, n 37; combination erythromycin/metoclopramide, n = 90) for feed intolerance. Stool microscopy, culture and CD toxin assay were performed in all patients who developed diarrhoea during and after prokinetic therapy. Diarrhoea was deemed to be related to CD infection if CD toxin was detected. RESULTS: Demographics, antibiotic use and admission diagnosis were similar amongst the three patients groups. Diarrhoea developed in 72 (40%) patients, 9.9 +/- 0.8 days after commencement of therapy, none of whom was positive for CD toxin or bacterial infection. Parasitic infections were found in four aboriginal men from an area endemic for these infections. Diarrhoea was most prevalent in patients who received combination therapy (49%) and was more common than in those who received erythromycin alone (30%) and metoclopramide alone (32%). Diarrhoea was short-lasting with a mean duration of 3.6 +/- 1.2 days. CONCLUSIONS: In critical illness, diarrhoea following the administration of erythromycin at prokinetic doses is not associated with CD but may be related to pro-motility effects of the agent. Prokinetic therapy should be stopped at the onset of diarrhoea and prophylactic use should be strictly avoided.
Authors: G Hernandez; N Velasco; C Wainstein; L Castillo; G Bugedo; A Maiz; F Lopez; S Guzman; C Vargas Journal: J Crit Care Date: 1999-06 Impact factor: 3.425
Authors: Marc A Ritz; Marianne J Chapman; Robert J Fraser; Mark E Finnis; Ross N Butler; Patricia Cmielewski; Geoffrey P Davidson; Deborah Rea Journal: Intensive Care Med Date: 2005-06-07 Impact factor: 17.440
Authors: C Landry; N Vidon; P Sogni; P Nepveux; J C Chaumeil; J P Chauvin; D Couturier; S Chaussade Journal: Eur J Gastroenterol Hepatol Date: 1995-08 Impact factor: 2.566
Authors: L Sabau; A Meybeck; J Gois; P Devos; P Patoz; N Boussekey; P-Y Delannoy; A Chiche; H Georges; O Leroy Journal: Infection Date: 2013-06-19 Impact factor: 3.553
Authors: Joanna C Dionne; Kristen Sullivan; Lawrence Mbuagbaw; Alyson Takaoka; Erick Huaileigh Duan; Waleed Alhazzani; John W Devlin; Matthew Duprey; Paul Moayyedi; David Armstrong; Lehana Thabane; Jennifer L Y Tsang; Roman Jaeschke; Cindy Hamielec; Tim Karachi; Rodrigo Cartin-Ceba; John Muscedere; Mohammed Saeed Saad Alshahrani; Deborah J Cook Journal: BMJ Open Date: 2019-06-27 Impact factor: 2.692
Authors: Massimo Antonelli; Elie Azoulay; Marc Bonten; Jean Chastre; Giuseppe Citerio; Giorgio Conti; Daniel De Backer; François Lemaire; Herwig Gerlach; Johan Groeneveld; Goran Hedenstierna; Duncan Macrae; Jordi Mancebo; Salvatore M Maggiore; Alexandre Mebazaa; Philipp Metnitz; Jerôme Pugin; Jan Wernerman; Haibo Zhang Journal: Intensive Care Med Date: 2008-12-09 Impact factor: 17.440