Q: What's the optimum time to administer erythromycin in patients who may require endoscopy in acute upper gastrointestinal (UGI) bleed?
Answer: Anywhere 30 to 90 minutes prior to endoscopy
Erythromycin is a prokinetic which promotes gastric emptying as it is an agonist of motilin receptors. It improves gastric emptying and so the visualization at endoscopy. Not only it excludes the need of second scope but there is weak evidence that it may even shortens the hospital stay.
It should be given as an intravenous (IV) over 20-30 minutes with the recommended dose of 3 mg/kg. 90 minutes prior to scope is ideal but as acute UGI can be a time-constrained situation, 30 minutes prior to endoscope is also acceptable.
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