To assess the link between very early erythromycin exposure and pyloric stenosis in young infants.
Retrospective cohort study.
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.
Hospital discharge diagnosis of pyloric stenosis, and an associated surgical procedure code.
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.
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.
"The frequent use of erythromycin in pregnant women has permitted the surveillance of long-term effects of this antimicrobial agent. These include infantile hypertrophic pyloric stenosis
, cardiac toxicity
 and maternal hepatotoxicity
. There is not yet enough data available to know whether the risks of toxicity in neonates are similar with newer macrolide antimicrobial agents
[Show abstract][Hide abstract] ABSTRACT: Genital mycoplasmas colonise up to 80% of sexually mature women and may invade the amniotic cavity during pregnancy and cause complications. Tetracyclines and fluoroquinolones are contraindicated in pregnancy and erythromycin is often used to treat patients. However, increasing resistance to common antimicrobial agents is widely reported. The purpose of this study was to investigate antimicrobial susceptibility patterns of genital mycoplasmas in pregnant women.
Self-collected vaginal swabs were obtained from 96 pregnant women attending an antenatal clinic in Gauteng, South Africa. Specimens were screened with the Mycofast Revolution assay for the presence of Ureaplasma species and Mycoplasma hominis. The antimicrobial susceptibility to levofloxacin, moxifloxacin, erythromycin, clindamycin and tetracycline were determined at various breakpoints. A multiplex polymerase chain reaction assay was used to speciate Ureaplasma positive specimens as either U. parvum or U. urealyticum.
Seventy-six percent (73/96) of specimens contained Ureaplasma spp., while 39.7% (29/73) of Ureaplasma positive specimens were also positive for M. hominis. Susceptibilities of Ureaplasma spp. to levofloxacin and moxifloxacin were 59% (26/44) and 98% (43/44) respectively. Mixed isolates (Ureaplasma species and M. hominis) were highly resistant to erythromycin and tetracycline (both 97% resistance). Resistance of Ureaplasma spp. to erythromycin was 80% (35/44) and tetracycline resistance was detected in 73% (32/44) of Ureaplasma spp. Speciation indicated that U. parvum was the predominant Ureaplasma spp. conferring antimicrobial resistance.
Treatment options for genital mycoplasma infections are becoming limited. More elaborative studies are needed to elucidate the diverse antimicrobial susceptibility patterns found in this study when compared to similar studies. To prevent complications in pregnant women, the foetus and the neonate, routine screening for the presence of genital mycoplasmas is recommended. In addition, it is recommended that antimicrobial susceptibility patterns are determined.
"Its safety and efficacy in improving feeding intolerance have been demonstrated in multiple studies with premature infants and children . However, there are reports showing that early exposure to erythromycin in the neonatal period significantly increases the risk of pyloric stenosis in infants [10,77]. Interestingly prolongation of QT, a well-known side effect of erythromycin , was not reported as an AE in a recent large pediatric retrospective study on gastroparesis . "
[Show abstract][Hide abstract] ABSTRACT: Historically, gastroparesis is characterized by delayed gastric emptying of fluids and/or solids without evidence of a mechanical gastric outlet obstruction. To provide a thorough, evidence-based overview of the diagnosis, treatment, outcome and future advances for gastroparesis in children, a web search (PubMed, Cochrane Database of Systematic Reviews, EMBASE, Clinical Evidence) was performed. Original articles and reviews were identified, examined and included as appropriate. The prevalence of gastroparesis is vague in adults and unknown in children. It is suspected on the presence of symptoms indicating gastric dysmotility (nausea, vomiting, early satiety, postprandial fullness, failure to thrive, weight loss) and is confirmed on the demonstration of delayed gastric emptying. It can be assessed with various methods from which gastric emptying scintigraphy of a radiolabeled solid meal is considered as the golden standard. Therapeutic approaches include: dietary modifications, medical treatment (prokinetics, antiemetics, intrapyloric injection of botulinum toxin, enteral feeds via jejunostomy, total parenteral nutrition) and surgical interventions (laparoscopic placement of gastric pacemaker) aiming at alleviating symptoms and maintaining optimal nutritional status. Gastroparesis in children can be challenging to diagnose and treat. Specific protocols for the evaluation of gastric emptying and for a stepwise management are required to optimise future outcomes.
Annals of Gastroenterology 03/2013; 26(3):204-211.
"Trimethoprim-sulfamethaxazole may be used for patients with an allergy to macrolides (Table 1). Erythromycin has been associated with a risk of pyloric stenosis when used in infants less than 1 month of age . Patients with pertussis should be placed in respiratory isolation to prevent further infections. "
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION – AGENTS: Respiratory failure is the most common cause of cardiopulmonary arrest in infants and children. Because morbidity may be time-dependent and appropriate treatment may vary significantly depending on etiology, prompt assessment and management of pediatric respiratory disease is essential. This chapter will discuss the most common respiratory diseases in children focusing on epiglottitis, bacterial tracheitis, croup, retropharyngeal abscess, pertussis, bronchiolitis, and pneumonia. EPIGLOTTITIS: Epidemiology: Epiglottitis or supraglottitis is a serious, life-threatening infection of the epiglottis and constitutes an airway emergency (see Chapter 8 for a discussion of supraglottitis). It is more common in the winter but can occur throughout the year. Peak incidence is in children between 2 and 8 years of age, but epiglottitis also occurs in infants and adults. Since widespread vaccination against Haemophilus influenzae type B, previously the most common cause, the incidence has decreased from 41 to 4.1 cases per 100,000, and the typical age of presentation is increasing. The most common identified organisms causing epiglottitis are now group A beta-hemolytic Streptococcus, Streptococcus pneumoniae, Klebsiella, Pseudomonas, and Candida. Clinical Features: Epiglottitis usually presents abruptly within 6–24 hours of a prodromal viral illness. Patients with epiglottitis classically have high fever, irritability, and throat pain that may manifest as unwillingness to eat or drink (Table 49.1).
Emergency Medicine Clinics of North America 12/2007; 25(4):961-79, vi. DOI:10.1016/j.emc.2007.07.006 · 0.78 Impact Factor
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