Pyloric stenosis and use of erythromycin

In March 1999, 7 children with pylorospasm who underwent a pylorotomy were treated in the children's surgery department of an American clinic for a period of 2 weeks. This series of cases led to an epidemiological study.

It turned out that all of the children were born in the same maternity unit in February, and all of them received erythromycin as part of a pertussis epidemic. The source of the infection was hospital staff. It was decided to appoint 200 children born in February in this maternity unit as erythromycin as a prophylactic. 7 children (including 6 boys) started receiving erythromycin on days 2-17 (on average 5 days) and treatment lasted 10-18 days (on average 14 days). It turned out that children born in February 1999 in this maternity unit were 7 times more likely to have pyloric stenosis compared to 1997 and 1998 (32.3: 1000 vs 4.7: 1000, respectively). In children born in this department in March-May 1999, there were no cases of pyloric stenosis.

In 1976, American pediatricians published the first report of 6 cases of pyloric stenosis in newborns, 5 of which received 40 mg / kg / day of erythromycin for various infectious diseases. 24 to 48 hours after the first dose of erythromycin, the newborns vomited. Before that, the frequency of pylorotomies was 1 in 400 to 600 newborns, in 1976, the frequency of pylorotomies had increased to 1: 160 newborns.

In 1986, a case of pyloric stenosis was reported in a newborn whose mother received erythromycin and continued to breastfeed her baby. The child developed symptoms from the gastrointestinal tract on the 5th day after starting the mother's treatment. Erythromycin is therefore contraindicated in breastfeeding because it can cause pyloric stenosis in a child.

Erythromycin is the drug of choice for the treatment of pertussis. However, the described cases of pyloric stenosis cause doctors to think. In many clinical studies, the anterior and duodenal prokinetic effects of erythromycin have been proven, but the efficacy of erythromycin in gastroparesis has not been proven. The 16-member macrolides (josamycin and spiramycin) can be used in newborns because they have no prokinetic effect.