Use of erythromycin for the treatment of severe chronic constipation in children

Abstract

The efficacy of erythromycin was assessed in the treatment of 14 children aged 4 to 13 years with refractory chronic constipation, and presenting megarectum and fecal impaction. A double-blind, placebocontrolled, crossover study was conducted at the Pediatric Gastroenterology Outpatient Clinic of the University Hospital. The patients were randomized to receive placebo for 4 weeks followed by erythromycin estolate, 20 mg kg -1 day -1 , divided into four oral doses for another 4 weeks, or vice versa. Patient outcome was assessed according to a clinical score from 12 (most severe clinical condition) to 0 (complete recovery). At enrollment in the study and on the occasion of follow-up medical visits at two-week intervals, patient score and laxative requirements were recorded. During the first 30 days, the mean ± SD clinical score for the erythromycin group (N = 6) decreased from 8.2 ± 2.3 to 2.2 ± 1.0 while the score for the placebo group (N = 8) decreased from 7.8 ± 2.1 to 2.9 ± 2.8. During the second crossover phase, the score for patients on erythromycin ranged from 2.9 ± 2.8 to 2.4 ± 2.1 and the score for the patients on placebo worsened from 2.2 ± 1.0 to 4.3 ± 2.3. There was a significant improvement in score when patients were on erythromycin (P < 0.01). Mean laxative requirement was lower when patients ingested erythromycin (P < 0.05). No erythromycin-related side effects occurred. Erythromycin was useful in this group of severely constipated children. A larger trial is needed to fully ascertain the prokinetic efficacy of this drug as an adjunct in the treatment of severe constipation in children. Correspondence

Currently recommended treatments of childhood constipation are not evidence based: a systematic literature review on the effect of laxative treatment and dietary measures

“…Table 3 presents the characteristics of the 28 included studies; there were 21 RCTs, 1 CCT26 and 6 crossover studies 15 17 25 30 37 42…”

“…Of the crossover studies four were hospital based, of which two were conducted at a general paediatric department15 30 and two were conducted in a paediatric gastroenterology department 17 25. Only one study was primary care based 37…”

Constipation in children

“…1 study of 14 children showed some significant results: Further evaluation through RCTs is needed to assess erythromycin as an adjunct in chronic constipation [73]. …”

Rifaximin, a Poorly Absorbed Antibiotic: Pharmacology and Clinical Potential

“…Besides constipation-related IBS, several studies have also suggested abnormalities of colonic bacterial composition in chronic idiopathic constipation [125]. Here again antibiotic treatment with vancomycin [126,127], rovamycin (in combination with diphetarsone, an amebicidal agent) [128,129] or erythromycin [130], which, however, displays a prokinetic activity [131,132], proved to be capable of reversing long-lasting constipation. Furthermore, the efficacy in both clinical conditions of probiotics [133][134][135] lends further support to the pathogenic role of bowel flora.…”