Erythromycin for the prevention and treatment of feeding intolerance in preterm infants

Ng, Eugene; Shah, Vibhuti

doi:10.1002/14651858.cd001815.pub2

Cited by 49 publications

(41 citation statements)

References 32 publications

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“…The median (IQR) age for infants prescribed erythromycin and azithromycin was 49 days (23-70) and 68 days (50-80; P , .001), respectively. The median number of days after exposure to erythromycin in which the 17 infants underwent pyloromyotomy was 13 days (range, 2-40; IQR, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. The median number of days between exposure to azithromycin in the 8 infants and subsequent pyloromyotomy was longer than the interval for the erythromycin group at 29.5 days (range, 9-45; IQR 20.5-38.5; P = .08).…”

Section: Resultsmentioning

confidence: 99%

“…Erythromycin has been shown to be a motilin receptor agonist, stimulating migrating motor complexes in the stomach. 14,15 Similarly, azithromycin acts as a motilin receptor agonist and causes long-lasting facilitation of cholinergic activity in experiments by using circular muscle of human gastric antrum. 16 Azithromycin has also been shown to stimulate antral activity and induce migrating motor complexes in the duodenum in patients with gastrointestinal dysmotility.…”

Section: Discussionmentioning

confidence: 99%

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Azithromycin in Early Infancy and Pyloric Stenosis

et al. 2015

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Azithromycin in Early Infancy and Pyloric Stenosis

et al. 2015

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“…It is important to recognize, however, that these concerns related to the cardiac adverse effects are extrapolated from reports or studies performed in non-critically ill patients. Thus far, there has been report of cardiac toxicities or arrhythmias with the use of metoclopramide or erythromycin in clinical studies that involved adults or pre-term infants during critical illness [31,34,[60][61][62] .…”

Section: Novel Prokinetic Agentsmentioning

confidence: 99%

Pharmacological therapy of feed intolerance in the critically ills

Nguyen¹

2014

WJGPT

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Feed intolerance in the setting of critical illness is associated with higher morbidity and mortality, and thus requires promptly and effective treatment. Prokinetic agents are currently considered as the first-line therapy given issues relating to parenteral nutrition and postpyloric placement. Currently, the agents of choice are erythromycin and metoclopramide, either alone or in combination, which are highly effective with relatively low incidence of cardiac, hemodynamic or neurological adverse effects. Diarrhea, however, can occur in up to 49% of patients who are treated with the dual prokinetic therapy, which is not associated with Clostridium difficile infection and settled soon after the cessation of the drugs. Hence, the use of prokinetic therapy over a long period or for prophylactic purpose must be avoided, and the indication for ongoing use of the drug(s) must be reviewed frequently. Second line therapy, such as total parenteral nutrition and post-pyloric feeding, must be considered once adverse effects relating the prokinetic therapy develop.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Adverse effects; Critical illness; Enteral feeding; Feed intolerance; Prokinetic therapyCore tip: Feed intolerance during critical illness must be promptly recognized and treated due to the associated morbidity and mortality. The current first line treatment for feed intolerance is prokinetic therapy with erythromycin and metoclopramide (alone or in combination), which are highly effective and free of significant adverse effects. Although diarrhoea occurs commonly after combination prokinetic therapy, it is not associated with Clostridium difficile colitis and settled shortly after stopping the treatment. The use of prokinetic therapy over a long period or for prophylactic purpose, therefore, must be avoided and the indication for ongoing use of the drug(s) should be frequently reviewed.Nguyen NQ. Pharmacological therapy of feed intolerance in the critically ills.

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“…At a dose of 1 mg/kg, erythromycin induces phase III of the MMC along the intestine [46]. Higher doses cause sustained contraction, followed by a prolonged disruption of the baseline MMC.…”

Section: Erythromycinmentioning

confidence: 99%

“…Higher doses cause sustained contraction, followed by a prolonged disruption of the baseline MMC. Clinical studies have demonstrated improved gastric motility and postoperative intestinal dysmotility with low-dose erythromycin [45,46]. Despite encouraging reports, a recent Cochrane systematic review examining 10 randomized controlled studies using both high-and low-dose erythromycin failed to document improvement in feeding tolerance in preterm infants [45,46].…”

Section: Erythromycinmentioning

confidence: 99%