ABSTRACT
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.Conclnsions 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.
ABSTRACT
Objective To evaluate the efficacy and safety of proton pump inhibitor (PPI)plus prokinetic drug on the treatment of laryngopharyngeal reflex .Methods According to predetermined criteria of inclusion and exclu-sion ,Cochrane Central Register of Controlled Trails(CENTRAL) ,Embase ,Elsevier ,Pubmed ,VIP ,Wanfang Data , CNKI and CBM were searched for the randomized controlled trails of proton pump inhibitor and prokinetic drug on the treatment of laryngopharyngeal reflex diseases from the date of establishment of the datebases to November 2012 .Revman 5 .1 software and GRAED profiler 3 .6 software were applied to analysis the data ,which was extrac-ted by three independent evaluators .Results A total of 346 related articles were obtained ,7 trails were included , 614 patients in total .The results of Meta -analysis showed that :the overall effictive rate of combination therapy with proton pump inhibitors plus prokinetic drug in patients with laryngopharyngeal reflex was higher than those in the control group [RR=1 .18 ,95% CI(1 .10 ,1 .28) ,P<0 .0001] .The rate of improvement of laryngeal signs exam-ined by fiberoptic laryngoscope was higher than those in the control group [RR= 1 .38 ,95% CI(1 .16 ,1 .65) ,P<0 .001] .The average relief time of dysphonia symptoms was shorter than those in the control group [MD = -1 .70 , 95 CI (-2 .95 ,-0 .45) ,P<0 .001] .Conclusion The effect of proton pump inhibitor plus prokinetic drug on the treatment of laryngopharyngeal reflex is superior to those of proton pump inhibitors or prokinetic drug only ,but in terms of safety ,more large-sample ,high-quality randomized controlled trails are required .