Are young infants treated with erythromycin at risk for developing hypertrophic pyloric stenosis?

Can you be too premature to develop pyloric stenosis?: Figure 1

“…Erythromycin, an antibiotic commonly used for treating pertussis in infants, has also been implicated in the causation of pyloric stenosis. Infants exposed to antimicrobial doses of erythromycin in the first few weeks of life appear to be at a greater risk for developing hypertrophic pyloric stenosis 9. The risk was reported to be substantially higher (8-fold to 10-fold) in the first 2 weeks of life, in term or near-term infants.…”

Drugs Acting on the Gut: Prokinetics, Antispasmodics, Laxatives

“…Erythromycin should not be used concurrently with medications metabolized by cytochrome P450 3A4 (CYP3A4) such as cisapride, terfenadine, pimozide, or astemizole as it is a CYP3A4 inhibitor. Caution must be used in young infants as there is an eight-to tenfold increased risk of developing hypertrophic pyloric stenosis in term or near-term infants when used within the fi rst 2 weeks of life and when the treatment course is >14 days [ 51 ]. There is insuffi cient data in the preterm infant population as to whether there is increased risk of pyloric stenosis and a recent review did not show increased incidence for this particular population for treatment of dysmotility due to immaturity of the gastrointestinal tract [ 52 ]; in fact, feeding tolerance may be improved with erythro mycin in preterm infants with very low birth weight [ 53 ].…”

Drugs Acting on the Gut: Prokinetics, Antispasmodics, Laxatives

“…Erythromycin should not be used concurrently with medications metabolized by cytochrome P450 3A4 (CYP3A4) such as cisapride, terfenadine, pimozide, or astemizole as it is a CYP3A4 inhibitor. Caution must be used in young infants as there is an eight-to tenfold increased risk of developing hypertrophic pyloric stenosis in term or near-term infants when used within the fi rst 2 weeks of life and when the treatment course is >14 days [ 41 ] . There is insuf fi cient data in the preterm infant population as to whether there is increased risk of pyloric stenosis and a recent review did not show increased incidence for this particular population for treatment of dysmotility due to immaturity of the gastrointestinal tract [ 42 ] .…”