The best-established use of erythromycin as a prokinetic agent is in patients with diabetic gastro-paresis, where erythromycin can improve gastric emptying in the short term. Erythromycin-stimulated gastric contractions can be intense and result in "dumping" of relatively undigested food into the small bowel. This potential disadvantage is exploited clinically to clear the stomach of undigestible residue such as plastic tubes or bezoars. Rapid development of tolerance to erythromycin, possibly by down-regulation of the motilin receptor, and undesirable (in this context) antibiotic effects have limited the use of this drug as a prokinetic agent.
A standard dose of erythromycin for gastric stimulation is 3 mg2kg intravenously or 200—250 mg orally every 8 hours. For small-bowel stimulation, a smaller dose (e.g., 40 mg intravenously) may be more useful, as higher doses may actually retard small-bowel motility.
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