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: 5.73). 08/2002; 156(7):647-50. DOI: 10.1001/archpedi.156.7.647
Source: PubMed


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.

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    • "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 [41], cardiac toxicity [42] and maternal hepatotoxicity [43]. There is not yet enough data available to know whether the risks of toxicity in neonates are similar with newer macrolide antimicrobial agents [13]. "
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    • "Its safety and efficacy in improving feeding intolerance have been demonstrated in multiple studies with premature infants and children [30]. 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 [78], was not reported as an AE in a recent large pediatric retrospective study on gastroparesis [5]. "
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    • "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 [42]. Patients with pertussis should be placed in respiratory isolation to prevent further infections. "
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