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December 1977

Preoperative Bowel Preparation: Erythromycin Base Serum and Fecal Levels Following Oral Administration

Arch Surg. 1977;112(12):1493-1496. doi:10.1001/archsurg.1977.01370120083010

• Serial serum and fecal erythromycin concentrations were measured in a group of ten healthy volunteers following oral intake of 3 gm of neomycin sulfate and 3 gm of erythromycin base over a ten-hour period, as is currently used in preoperative intestinal preparation prior to colon resection. Four of the subjects underwent dietary restriction for three days in addition to neomycin and erythromycin base, while six subjects underwent three days of both dietary restriction and mechanical cleansing in addition to the antibiotics.

Subjects undergoing mechanical bowel cleansing had a significantly higher mean cumulative concentration of erythromycin in feces. The peak mean cumulative amount of fecal erythromycin was 600 mg after mechanical cleansing and 200 mg in the group not undergoing mechanical bowel cleansing. The peak mean serum erythromycin concentrations were not statistically different in the two treatment groups. Those receiving mechanical cleansing had peak mean serum concentrations of 6.35 μg/ml, while in those without mechanical cleansing, the serum level was 4.89 μg/ml.

Mechanical bowel cleansing is a critical part of the neomycin-erythromycin base preoperative bowel preparation. It is postulated that mechanical cleansing prior to the oral antibiotic administration improves the local concentration of intraluminal antibiotic by shortening the gastrointestinal transit time and by eliminating gross stool.

(Arch Surg 112:1493-1496, 1977)