Article

Very early exposure to erythromycin and infantile hypertrophic pyloric stenosis.

Department of Pediatrics, Division of General Pediatrics, Vanderbilt University School of Medicine, Suite 5028 MCE, Nashville, TN 37232-8555, USA.
Archives of Pediatrics and Adolescent Medicine (Impact Factor: 4.25). 08/2002; 156(7):647-50. DOI: 10.1001/archpedi.156.7.647
Source: PubMed

ABSTRACT 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.

0 Followers
 · 
115 Views
  • Source
    [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.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of the study is to evaluate a large series of infantile hypertrophic pyloric stenosis (IHPS) patients treated by one pediatric surgeon focusing on their diagnostic difficulties and complications. From July 1969 to December 2003 (inclusive), the charts of 791 infants with IHPS were retrospectively reviewed. There were 647 (82 %) males and 144 (18 %) females; mean age was 38 days, median 51 (range 7 days-10 months). When ultrasonography (US) was routinely used (1990), the age at diagnosis decreased to <40 days. The mean weight before and after routine US was 3.2 kg, median 3 (range 1.5-6). Twenty-five (3.1 %) were premature at diagnosis, mean age 49 days, median 56, (range 1-3 months) and mean weight 2.5 kg, median 2.3 (range 1.5-3.2). Eighty-one (10 %) had a positive family history. Forty-four (5 %) were non-Caucasians. Seventy-five (9 %) had other medical conditions, anomalies and/or associated findings. Sixty (7 %) patients had abnormal preoperative electrolytes. Ten (1.2 %) pylorics occurred after newborn operations. Of the entire total (791) who were treated, there were 13 (1.7 %) not operated on. All operations were done open initially through one of two right upper quadrant incisions, and then through an upper midline incision under general endotracheal anesthesia; 14 (1.7 %) had concomitant procedures. Prophylactic antibiotics (from 1982) decreased the wound infection rate to 3.9 %. There were a total of 87 (10 %) complications which included 9 (1.1 %) intraoperative, (including mistaken diagnoses) 78 (9 %) postoperative: 59 (2 %) early (<1 month) and 19 (2.4 %) late (>1 month). The 13 (1.6 %) postoperative transfers (12 from non-pediatric surgeons) had 16 (18 %) complications (including 1 death); five (33 %) requiring reoperation (4 incomplete, 1 perforation). There were two deaths. IHPS should be considered in any vomiting infant. US allows earlier diagnosis. Serious complications are uncommon and avoidable, but recognizable and easily corrected. Higher surgeon volume of pyloromyotomies (>14 per year) is associated with fewer complications.
    Pediatric Surgery International 03/2014; 30(5). DOI:10.1007/s00383-014-3488-8 · 1.06 Impact Factor
  • Source
    [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.
    BMC Infectious Diseases 03/2014; 14(1):171. DOI:10.1186/1471-2334-14-171 · 2.56 Impact Factor

Gerald B Hickson