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Prokinetic drug therapy in children: a review of current options

Michael F Chicella1, L Arturo Batres, Michael S Heesters

  • 1Department of Pharmacy, Children's Hospital of The King's Daughters, Norfolk, VA 23507-1910, USA. Chicelmf@chkd.org

The Annals of Pharmacotherapy
|March 10, 2005
PubMed

Insights

Erythromycin is a recommended prokinetic agent for pediatric gastroesophageal reflux (GER) when acid suppression alone is insufficient. Metoclopramide lacks sufficient evidence for GER treatment in children and carries potential risks.

Area of Science:

  • Pediatric Gastroenterology
  • Pharmacology
  • Drug Efficacy and Safety

Background:

  • Gastroesophageal reflux (GER) is common in children.
  • Prokinetic agents are sometimes used with acid suppression for GER management.
  • Metoclopramide and erythromycin are commonly considered prokinetic agents for pediatric GER.

Purpose of the Study:

  • To review the pharmacology, safety, and efficacy of metoclopramide and erythromycin in children with GER.
  • To evaluate the evidence supporting the use of these prokinetic agents in pediatric GER treatment.

Main Methods:

  • Literature search of MEDLINE (1970-June 2004) using terms related to metoclopramide, erythromycin, GER, and gastrointestinal motility.
  • Inclusion of abstracts and original research articles, with preference for controlled trials.
  • Review of articles detailing pharmacology, safety, and effectiveness for GER treatment.

Main Results:

  • Erythromycin has demonstrated efficacy in improving feeding tolerance in children, with uncommon adverse drug reactions in controlled trials.
  • Limited data support metoclopramide's use for GER in children, and its potential adverse effects require careful consideration.
  • Some evidence suggests prokinetic agents may be beneficial alongside acid suppression for pediatric GER.

Conclusions:

  • Erythromycin is supported by literature as a prokinetic agent for pediatric GER when needed.
  • Acid suppression alone may suffice for many children with GER.
  • Metoclopramide is not recommended for pediatric GER due to insufficient evidence of efficacy and safety.
Abstract

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