Administration of Neomycin and Erythromycin During NPO Status

Rationale for Administration During NPO Status

• Oral neomycin and erythromycin are frequently used as prophylactic antibiotics for bowel preparation before colorectal surgery and are specifically designed to be given when patients are NPO 1
• These medications are listed in guidelines as "for bowel preparation" with variable dosing, indicating they are meant to be administered during the pre-procedure NPO period 1
• Verify that the neomycin and erythromycin are indeed prescribed for bowel preparation before a procedure, as this is their most common indication when given together 1

Important Considerations

• If the patient has swallowing difficulties related to their NPO status, alternative routes of administration should be considered 2, 3
• For patients who are NPO due to stroke, oral medications should not be administered until a swallowing screen has been completed and found normal 2

Administration Protocol

• If the patient is NPO for bowel preparation before a procedure, administer the medications as scheduled at 2am 1
• If the patient is NPO due to swallowing concerns, verify if a swallowing assessment has been completed before administering oral medications 2

Potential Pitfalls

• Do not withhold these medications simply because the patient is NPO for a procedure, as this is precisely when they are intended to be given 1
• Be aware that erythromycin can cause gastrointestinal side effects including epigastric distress, abdominal cramps, nausea, and diarrhea 4
• Verify that the patient doesn't have contraindications to either medication, such as hypersensitivity to macrolide antibiotics for erythromycin 4