Abstract
Problems with antibiotic resistant bacteria are increasing in the hospital and particularly in the intensive care unit. Methicillin-resistant Staphylococcus aureus, Acinetobacter baumanii and extended spectrum beta-lactamase producing Gram-negative bacilli constitute a therapeutic and infection control challenge. Early enteral feeding improves survival in patients in the intensive care unit. Prokinetic agents are routinely used in patients with inappropriate gastrointestinal motility. The use of erythromycin at sub-therapeutic doses as a prokinetic agent is a cause of concern for the following reasons: it can increase the emergence and spread of antibiotic resistance and the likelihood of Clostridium difficile disease. The use of an antibiotic as a prokinetic agent does not constitute prudent antimicrobial prescribing and should be avoided. Alternative agents, whenever possible, should be used.
Highlights
The mechanisms by which antibiotic use can increase antibiotic resistance have been reviewed by Lipsitch and Samore [3] and include: selecting in favour of resistant strains; creating colonization opportunities for resistant strains; and encouraging an increased colonisation ‘load’
We recently conducted an observational carriage study that supported the view that methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus strains compete for colonisation space in the anterior nares [4]
Hospitals in North America and Europe are experiencing a rise in C. difficile infections in the inpatient population caused by a strain (NAP1/027) that is characterized by increased toxin production [7]
Summary
Clinical Practice Guidelines for Nutritional Support in Mechanically Ventilated, Adult Critically Ill Patients. Talle NJ, Tack J, Peeters T: What comes after macrolides and other motility stimulants? Talle NJ, Tack J, Peeters T: What comes after macrolides and other motility stimulants? Gut 2001, 49:317-318
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