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Erythromycin plus metoclopramide combination therapy compared with erythromycin or metoclopramide monotherapy for postpyloric spiral nasoenteric tube placement: a multicenter, open-label, randomized controlled superiority trial

Year: 2025

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: BACKGROUND: For critically ill adults with postpyloric feeding, using prokinetic agents to facilitate transpyloric migration is a sensible strategy, and many randomized controlled trials have demonstrated erythromycin and metoclopramide improve the success rate of postpyloric placement of spiral nasoenteric tubes (NETs). OBJECTIVES: To determine whether a combination of erythromycin and metoclopramide is superior to monotherapy with either agent for facilitating the postpyloric placement of self-propelled spiral NETs in critically ill adults. METHODS: A multicenter, open-label, parallel-group, randomized controlled superiority trial was conducted across the intensive care units of 5 tertiary hospitals in China. Critically ill adults requiring postpyloric feeding were randomly assigned (1:1:1) to receive either erythromycin plus metoclopramide, erythromycin alone, or metoclopramide alone. The primary outcome was successful postpyloric placement. This outcome was analyzed using generalized linear mixed models. RESULTS: A total of 1138 patients were screened for eligibility, among whom 777 required NETs placement. Of them, 256 were assigned to the combination group, 261 to the erythromycin group, and 260 to the metoclopramide group. In the intention-to-treat analysis, the success rate for postpyloric placement was 48.0% (123/256) in the combination group, compared with 45.6% (119/261) in the erythromycin group (odds ratio 0.90; 95% confidence interval: 0.63, 1.27; P = 0.54) and 50.8% (132/260) in the metoclopramide group (odds ratio: 1.13; 95% confidence interval: 0.80, 1.61; P = 0.49). Drug-related adverse events were reported in 30 patients (11.7%) in the combination group, which was higher compared with 11 patients (4.2%) in the metoclopramide group (P = 0.002). CONCLUSIONS: The combination therapy of erythromycin and metoclopramide was not superior to erythromycin or metoclopramide monotherapy in facilitating postpyloric placement of spiral NETs in critically ill patients. However, the combination therapy was associated with a higher incidence of drug side effects compared with the metoclopramide monotherapy. The trial was registered with https://www.chictr.org.cn/showprojEN.html?proj=33960 (trial ID ChiCTR1900022508).

Source: American Journal of Clinical Nutrition

DOI: 10.1016/j.ajcnut.2025.09.043