Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL 32610, USA.
Dig Dis Sci. 2010 Mar;55(3):675-83. doi: 10.1007/s10620-009-1038-3.
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.
This study aims to determine whether azithromycin stimulates antral activity in patients with chronic gastrointestinal pain and refractory gastroparesis.
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.
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).
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 maybe a potential new medication for the treatment of gastroparesis and gastrointestinal dysmotility.
由于可供选择的方案有限，目前治疗胃轻瘫的药物治疗效果并不理想。依托红霉素是一种有效的促动力药物，可刺激胃排空。最近，依托红霉素因 QT 延长而导致突发性心脏死亡的事件时有发生。阿奇霉素在结构上与红霉素相似，但与红霉素不同，它没有明显的药物相互作用。
本研究旨在确定阿奇霉素是否能刺激慢性胃肠道疼痛和难治性胃轻瘫患者的胃窦活动。
对 30 名接受慢性消化问题临床评估或有明确难治性胃轻瘫的患者进行小肠测压的临床数据进行回顾。在小肠测压过程中，以不同时间间隔静脉输注红霉素 250mg 和阿奇霉素（500 或 250mg）后，测量胃窦活动。测量的参数包括总作用持续时间、胃窦收缩的平均幅度、胃窦收缩最高阶段的持续时间、每分钟周期数和运动指数。
比较相似剂量的依托红霉素和阿奇霉素，发现它们对胃窦活动有相似的积极作用。然而，比较高剂量 500mg 的依托红霉素和阿奇霉素，发现阿奇霉素的平均幅度、胃窦活动的持续时间和运动指数显著增加（P <0.05）。
阿奇霉素刺激胃窦活动的作用与依托红霉素相似，而且作用持续时间更长。然而，与依托红霉素不同的是，阿奇霉素没有明显的药物相互作用，可能是治疗胃轻瘫和胃肠道动力障碍的一种潜在新药物。
