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Comparison of the Effect of Azithromycin Versus Erythromycin on Antroduodenal Pressure Profiles of Patients with Chronic Functional Gastrointestinal Pain and Gastroparesis

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Abstract

Background

Current pharmacologic treatments for gastroparesis have been disappointing due to the limited options available. Erythromycin ethylsuccinate is a potent prokinetic agent that stimulates gastric emptying. Recently, erythromycin has been linked to the occurrences of sudden cardiac death due to QT prolongation. Azithromycin is similar to erythromycin in structure but does not have significant drug–drug interactions as seen with erythromycin.

Purpose

This study aims to determine whether azithromycin stimulates antral activity in patients with chronic gastrointestinal pain and refractory gastroparesis.

Methods

Small bowel manometric data on 30 patients undergoing clinical evaluation for chronic digestive problems or documented refractory gastroparesis were reviewed. Antral activity was measured after infusion of erythromycin 250 mg intravenous and azithromycin (500 or 250 mg intravenous) given at different intervals during the small bowel manometry. The parameters measured included the total duration of effect, mean amplitude of antral contractions, duration of the highest antral contraction phase, number of cycles per minute, and the motility index.

Results

Comparison of erythromycin and azithromycin at similar doses showed a similar positive effect on antral activity. However, comparison of erythromycin and azithromycin at the higher dose of 500 mg showed that the mean amplitude, duration of antral activity, and motility index were significantly increased with azithromycin (P < 0.05).

Conclusions

Azithromycin stimulates antral activity similar to erythromycin and moreover has a longer duration of effect. However, unlike erythromycin, azithromycin does not have significant drug–drug interactions and may be a potential new medication for the treatment of gastroparesis and gastrointestinal dysmotility.

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Acknowledgments

My sincere thanks to G. N. Verne, M.D., for his mentorship throughout my gastroenterology fellowship training, Jane Y. Douglas PhD for her eager help with the language and writing portion, Thomas Baumgartner, Pharm.D. for his unique idea regarding azithromycin’s lack of P450 interaction, and James I. Slaff, M.D. who was such an enthusiastic and passionate physician scientist, friend, and colleague and a true inspiration to us all.

Financial support: None, Grant Support: None, Potential competing interests: None.

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Nutrition, University of Florida, 1600 Southwest Archer Road, PO Box 100214, Gainesville, FL, 32610, USA

    Baharak Moshiree, Renee McDonald & Phillip P. Toskes

  2. Division of Biostatistics, Department of Epidemiology and Health Policy Research, University of Florida, Gainesville, FL, USA

    Wei Hou

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  1. Baharak Moshiree
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  2. Renee McDonald
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Correspondence to Baharak Moshiree.

Additional information

Baharak Moshiree, M.D., and Phillip P. Toskes, M.D. are the guarantors of the article.

Specific author contributions: Baharak Moshiree and Phillip P. Toskes: Design of study, interpretation of the antroduodenal manometry, data collection, writing of the manuscript, and approval of the final version; Renee McDonald: performing the antroduodenal manometry and approval of the final version; Wei Hou: Statistical analysis of data and approving of the final version.

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Moshiree, B., McDonald, R., Hou, W. et al. Comparison of the Effect of Azithromycin Versus Erythromycin on Antroduodenal Pressure Profiles of Patients with Chronic Functional Gastrointestinal Pain and Gastroparesis. Dig Dis Sci 55, 675–683 (2010). https://doi.org/10.1007/s10620-009-1038-3

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  • DOI: https://doi.org/10.1007/s10620-009-1038-3

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