We are going to start a trial of Erythromycin tomorrow to see if we can slow or stop Daniel's vomiting at meals. I have two questions.

First, Daniel almost always vomits during or immediately following a feeding. It is VERY rare for him to vomit more than 10 or 15 minutes after a meal. As this medicine is supposed to help with the speed of emptying his stomach, could this possibly work fast enough?

Second, I'm not sure when to give it. The prescription is written for 1.5 ml every 8 hours. However, when you factor in sleep, he's not awake enough to space it that way. He currently takes his Nexium at approximately 7:30am and again at 7:30pm. Can I give him the Erythromycin at the same times with a dose in between? And, because it's supposed to be given with a meal, can I do it with his lunch at approximately 12:30 or 1:00pm? This would not make for evenly spaced dosing, nor is it 8 hours apart. Will this have an effect on how well it works?

Thank you for your help.
Jackie

jackie, erythromycin's use as a motillity agent is not officially on it's monograph, but it has been used successfully for this purpose when given both i.v and orally three times daily at anywhere from 1-4 mg/kg. 3mg/kg has been found in adults to be most effective. It is generally under the antimicrobial level and gives a 200-250 mg dose for an adult with GERD. Don't worry about the dose you are giving now just working for that one meal. With repeated three times daily dosing it should be working all of the time to empty the stomach, which is what you are looking for. Although is is best given with food, this doesn't help much if it won't stay down long enough to get absobed. Try initially giving it with small amounts of food to get Daniel used to it and after a while when it starts working you can try it with a full meal each time.
Regarding the administration with Nexium, the problem is the food issue. Erythromycin is with food, Nexium is on an empty stomach before the meal. By the way, the evening dose may not be working as well as it should if you are not following it about an hour later with a meal.
With kids and antibiotics I usually tell mom to not wake the child up but to give it when they are awake. In your case, it might be worth it to try to give it as evenly spaced apart as you can, at least to start, until it shows some signs of working.
Good luck, Graham Ph.C.