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Review article: erythromycin as a prokinetic agent in infants and children
J I Curry1, T D Lander, M D Stringer
1British Association of Paediatric Surgeons, The Royal College of Surgeons of England, London, UK. mcurry624@netscapeonline.co.uk
Insights
Erythromycin, at low doses, effectively improves gastrointestinal motility and feeding tolerance in children. This antibiotic demonstrates significant prokinetic benefits with a favorable safety profile in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Pharmacology
Background:
- Erythromycin, an antibiotic, exhibits prokinetic effects on the gastrointestinal tract at sub-antimicrobial doses.
- Pediatric gastrointestinal dysmotility is common, with limited therapeutic options, especially after cisapride withdrawal.
Purpose of the Study:
- To review the literature on the prokinetic effects of erythromycin in pediatric populations.
- To assess the efficacy and safety of erythromycin for treating pediatric gastrointestinal dysmotility.
Main Methods:
- Literature review of studies investigating erythromycin's prokinetic action in infants and children.
- Analysis of studies involving premature infants, low birth-weight infants, and older children with various GI disorders.
Main Results:
- Erythromycin demonstrated beneficial effects in promoting enteral feeding tolerance and enhancing gastrointestinal motility across various pediatric conditions.
- Both oral (ethylsuccinate, estolate) and intravenous (lactobionate) administration showed efficacy.
- No serious adverse effects were reported for prokinetic use, unlike potential risks at antibiotic doses in neonates.
Conclusions:
- Erythromycin is a safe and effective prokinetic agent for pediatric gastrointestinal dysmotility.
- Its use offers a valuable therapeutic option for children with feeding intolerance and motility issues.
Abstract:
Erythromycin has been used as an antibiotic for more than four decades, but only in the last 10 years have other therapeutic benefits of this agent been exploited. Animal and human studies have demonstrated a prokinetic effect on the gastrointestinal tract at sub-antimicrobial doses (typically a quarter or less of the antibiotic dose). A limited number of studies have been performed in children to investigate this action. A review of this literature is particularly pertinent given the frequency of clinical problems related to gastrointestinal dysmotility in children and the limited availability of prokinetic agents in paediatric practice, compounded by the recent withdrawal of cisapride. The prokinetic effects of erythromycin have been investigated in infants with dysmotility associated with prematurity, in low birth-weight infants recovering from abdominal surgery, and in older children with a variety of other gastrointestinal disorders. Only one randomized placebo-controlled trial has been conducted. All except one of these studies have shown a beneficial effect of erythromycin in either promoting tolerance of enteral feeds or enhancing a measured index of gastrointestinal motility. Erythromycin appears to be equally effective when given orally (as ethylsuccinate or estolate) or intravenously (as lactobionate). Significantly, no serious adverse effects have been reported in studies in which erythromycin has been used for its prokinetic effects, although fatal reactions have followed the intravenous administration of erythromycin to neonates in antibiotic doses.