Effect of Amoxicillin/Clavulanate on Gastrointestinal Motility in Children

Abstract

In children, administration of A/C directly into the small bowel before a meal induces phase III-type contractions in the duodenum, with characteristics similar to those present in the fasting state. These data suggest the possible use of A/C as a prokinetic agent. Further studies are needed to clarify its specific mechanism of action and the group of patients most likely to benefit from its use.

Chronic intestinal pseudo‐obstruction in children and adults: diagnosis and therapeutic options

“…The efficacy and main features related to various drugs, such as erythromycin, metoclopramide, domperidone, somatostatin analogues (octreotide and lanreotide), cholinesterases inhibitors (neostigmine and pyridostigmine), serotoninergic agents (such as 5‐hydroxytryptamine receptor 4 ‐ 5‐HT 4 ‐ agonists, e.g. prucalopride), prostaglandins and gonadotropin‐releasing hormone analogues (leuprolide), have been reported in a number of pediatric and adult CIPO studies (Table ) . Erythromycin is a macrolide antibiotic mimicking the prokinetic hormone motilin that induces phase III of the MMC.…”

“…Small intestinal bacterial overgrowth is known to cause mucosal inflammation, which further impairs GI motility thereby contributing to nausea, bloating, and abdominal distension . Various antibiotic regimens have been recommended .…”

“…prucalopride), prostaglandins and gonadotropin-releasing hormone analogues (leuprolide), have been reported in a number of pediatric and adult CIPO studies (Table 3). [96][97][98][99][100][101][102][103][104][105][106][107][108][109][110][111][112] Erythromycin is a macrolide antibiotic mimicking the prokinetic hormone motilin that induces phase III of the MMC. It has shown to be effective (at a dose of 1.5-2 g/day in adults or 3-5 mg/kg/dose in children) in accelerating gastric emptying and improving symptoms of CIPO in case reports.…”

“…Nonetheless, most clinicians use 1-to 2-week rotation of broad-spectrum antibiotics such as amoxicillin and clavulanic acid, gentamicin, and metronidazole, often combined with an antifungal compound (e.g., nystatin or fluconazole) followed by antibiotic-free periods 2. Notably, amoxicillin-clavulanate has been shown to combine antibiotic and enterokinetic properties in children 111. Non-narcotic pain modulators, such as tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors, should be used with caution in CIPO patients due to their significant side effects (i.e.…”

Drugs Acting on the Gut: Prokinetics, Antispasmodics, Laxatives

“…In a study of 20 patients undergoing antroduodenal motility testing, administration of 20 mg/kg of amoxicillin/clavulanate into the small bowel induced a duodenal phase III motility pattern in two out of ten patients receiving the medication 1 hour after a meal, and in nine out of ten patients receiving the medication 1 h before a meal [ 142 ]. Further studies are needed to determine the role of amoxicillin/clavulanate as a prokinetic agent.…”