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Very early exposure to erythromycin and infantile hypertrophic pyloric stenosis
William O Cooper1, Marie R Griffin, Patrick Arbogast
1Department of Pediatrics, Division of General Pediatrics, Vanderbilt University School of Medicine, Suite 5028 MCE, Nashville, TN 37232-8555, USA. william.cooper@mcmail.vanderbilt.edu
Insights
Very early erythromycin exposure in infants significantly increases the risk of pyloric stenosis by nearly eightfold. This association highlights the need to carefully consider erythromycin risks versus benefits in neonates.
Area of Science:
- Pediatric Gastroenterology
- Neonatal Pharmacology
- Public Health
Background:
- Pyloric stenosis is a significant concern in infant health.
- Erythromycin is a commonly prescribed antibiotic for infants.
- Previous studies have suggested a potential link between erythromycin and pyloric stenosis.
Purpose of the Study:
- To investigate the association between early-life erythromycin exposure and the incidence of pyloric stenosis in infants.
- To quantify the risk of pyloric stenosis associated with specific timing of erythromycin exposure.
Main Methods:
- Retrospective cohort study utilizing Medicaid and TennCare birth data from Tennessee (1985-1997).
- Identified infant cases of pyloric stenosis through hospital discharge diagnoses and surgical procedure codes.
- Assessed antibiotic exposure, specifically erythromycin, within the first 90 days of life from prescription records.
Main Results:
- A cohort of 933,239 births was analyzed, with 314,029 enrolled in Medicaid.
- 804 infants (2.6/1000) were diagnosed with pyloric stenosis.
- Very early erythromycin exposure (3-13 days) showed an almost 8-fold increased risk (aIRR, 7.88; 95% CI, 1.97-31.57).
- No increased risk was observed for later erythromycin exposure or exposure to other antibiotics.
Conclusions:
- Early erythromycin exposure in infants is strongly linked to an increased risk of pyloric stenosis.
- The findings are consistent with prior research on this association.
- Clinicians should carefully weigh the benefits and risks before prescribing erythromycin to young infants.
Objective:
To assess the link between very early erythromycin exposure and pyloric stenosis in young infants.
Design:
Retrospective cohort study.
Participants And Methods:
Medicaid or TennCare (Tennessee's program for Medicaid enrollees and uninsured individuals) births in Tennessee from 1985 to 1997. Cases of infants with a hospital discharge diagnosis of pyloric stenosis and an associated surgical procedure code were used. Erythromycin exposure and other antibiotic exposure between 3 and 90 days of life were identified from prescription files.
Main Outcome Measures:
Hospital discharge diagnosis of pyloric stenosis, and an associated surgical procedure code.
Results:
Of 933 239 births in Tennessee during the study period, 314 029 were enrolled in Medicaid. Among these infants, 804 (2.6/1000 infants) met the criteria for pyloric stenosis. Very early exposure to erythromycin (between 3 and 13 days of life) was associated with a nearly 8-fold increased risk of pyloric stenosis (adjusted incident rate ratio, 7.88; 95% confidence interval, 1.97-31.57). No increased risk of pyloric stenosis was seen in infants exposed to erythromycin after 13 days of life or in infants exposed to antibiotics other than erythromycin.
Conclusions:
The significant increase in pyloric stenosis in children with very early exposure to erythromycin is consistent with reports of other investigators. The risks and benefits of erythromycin should be weighed carefully prior to initiating such therapy in young infants.