[Erythromycin for improving enteral nutrition tolerance in adult critical patients: a systematic review and meta-analysis].

OBJECTIVE To systematically review the efficacy and safety of erythromycin on enteral nutrition (EN) tolerance in adult critical care patients. METHODS Databases including PubMed, EMbase, the Cochrane Library, CNKI and Wangfang data were retrieved up to June, 2013 to collect the randomized controlled trial (RCT) concerning erythromycin in improving EN tolerance or increasing the successful rate of postpyloric EN tube as compared with other treatments. Two reviewers independently screened the literature, extracted the data, and assessed the quality of methodology. Then Meta-analysis was performed using RevMan 5.2 software. RESULTS A total of 16 RCTs were included. Ten RCTs involving 668 patients were included for evaluating erythromycin in improving EN tolerance. Six RCTs involving 353 patients were included for evaluating erythromycin to increase the successful rate of postpyloric EN tube. The result of Meta-analysis showed that compared with placebo, erythromycin could significantly improve the successful rate of postpyloric EN tube placement [relative risk (RR)=1.82, 95% confidence interval (95%CI) 1.40-2.37, P<0.000 01], while there was no significant difference between erythromycin and metoclopramide (RR=1.04, 95%CI 0.79-1.36, P=0.799). In patients who needed early EN, compared with placebo or blank control, erythromycin had higher successful gastric feeding rate over 5 days (RR=1.89, 95%CI 1.19-3.00, P=0.007). In patients who failed EN, compared with metoclopramide, erythromycin could significantly increase the successful gastric EN rate for 24 hours (RR=1.30, 95%CI 1.02-1.66, P=0.03), 72 hours (RR=1.57, 95%CI 1.15-2.14, P=0.005) and 144 hours (RR=2.04, 95%CI 1.23-3.37, P=0.006). The median time of EN intolerance was postponed in erythromycin group than that in metoclopramide group. Adverse reactions were reported in 5 studies. There was no statistic difference except for the higher diarrhea rate in the combination treatment group compared with erythromycin group. CONCLUSIONS Postpyloric EN tube placement rate can be improved by erythromycin, which could be a choice of substitute for bedside intubation without fluoroscopy or endoscopic assistance. Based on the evidence, we recommended that intravenous erythromycin in a small dose of approximately 3 mg/kg weight as an option for EN intolerance in critical patients.