Erythromycin and feeding intolerance in premature infants: a randomized trial

Aly, Hany; Abdel‐Hady, Hesham; Khashaba, Mohamed; El-Badry, N

doi:10.1038/sj.jp.7211618

Cited by 41 publications

(34 citation statements)

References 16 publications

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“…Four clinical trials used low doses (3-15 mg/kg/day administered either orally or intravenously) [13][14][15][16] , whereas the other 3 trials used either an intermediate/ high dose tapering regimen (40 mg/kg for 2 days followed by 16 mg/kg for 5 days) [17] or high doses (50 mg/day) [18,19] . It is worth noting that all patients in the 'pilot' study by Ng et al [18] were included in the final analysis of their 'outcome' study [19] .…”

Section: Review Of Rctsmentioning

confidence: 99%

Use of Oral Erythromycin for the Treatment of Gastrointestinal Dysmotility in Preterm Infants

2008

Neonatology

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Milk intolerance due to functional gastrointestinal (GI) dysmotility is a common problem in preterm infants. In the past decade, erythromycin has been used for its motilinomimetric effect to facilitate enteral feeding in preterm infants. Although earlier studies suggested that erythromycin is an effective prokinetic agent, recent randomized control trials (RCTs) reveal conflicting findings. This review assesses the evidence from all RCTs performed to date on erythromycin for preterm infants. The results suggest that oral erythromycin administered in intermediate or high doses as a rescue treatment is associated with a shorter time to attain full enteral feeding and decrease in the duration of requirement for parenteral nutrition. More importantly, the outcome study further indicates that oral erythromycin can reduce the incidence of parenteral nutrition-associated cholestasis by almost 50% and decreases the incidence of recurrent septicemia. None of the RCTs reported any sinister adverse effects, in particular, hypertrophic infantile pyloric stenosis or fatal cardiac arrhythmia. Nonetheless, as long-term outcomes have not been fully evaluated, neonatologists should use this treatment cautiously and selectively in preterm infants with moderately severe GI dysmotility.

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Section: Review Of Rctsmentioning

confidence: 99%

Use of Oral Erythromycin for the Treatment of Gastrointestinal Dysmotility in Preterm Infants

2008

Neonatology

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“…Although it should be noted that in some studies, no significant difference was found between the placebo and erythromycin groups. [23][24][25] When we compared GGT level between the UDCA and erythromycin groups after treatment, GGT level was found to be A comparison of erythromycin and UDCA in premature infants T Gokmen et al significantly higher in the erythromycin group. Our findings suggest that UDCA was the most effective agent for preventing cholestasis.…”

Section: Discussionmentioning

confidence: 96%

A controlled trial of erythromycin and UDCA in premature infants during parenteral nutrition in minimizing feeding intolerance and liver function abnormalities

et al. 2011

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Objective: To compare the effectiveness of oral erythromycin versus ursodeoxycholic acid (UDCA) treatment in preventing feeding intolerance and liver function abnormalities.Study Design: A prospective, double blind, randomized, controlled trial in which three groups of preterm infants (birth weight <1500 g) were randomized to erythromycin (12.5 mg kg À1 per day), UDCA (5 mg kg À1 every 6 h) or placebo treatment. During the period 352 infants were admitted to our unit of which 75 infants whose parents accepted participation were enrolled in the study. Full enteral feeding or intestinal failure-associated liver disease was considered as the primary outcome measures.Results: Time to achieve full feeding after beginning the treatment was significantly shorter in the erythromycin group (P ¼ 0.014). g-Glutamyl transpeptidase levels in the placebo group were significantly higher than in the intervention groups (P ¼ 0.001). GTT level was slightly lower in UDCA groups than erythromycin. Conclusion:Oral erythromycin was most effective in facilitating enteral feeding and UDCA was most effective in preventing cholestasis in very low birth weight infants. Prophylactic usage of UDCA could be considered in infants with prolonged parenteral nutrition.

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“…2 Similarly, Aly et al found a significant benefit in preterm infants >32 weeks [10.5 (4.1) vs. 16.3 (5.7) days, respectively, with low-dose erythromycin (1 mg/ kg t.i.d) compared to placebo. 1 Furthermore, a Jakarta study found no significant difference in the use of lowdose erythromycin (3 mg/kg q.i.d.) in preterm infants compared to placebo.…”

Section: Discussionmentioning

confidence: 98%

“…The most common cause of feeding intolerance is low gut motility due to prematurity. 1,2 Prokinetics are commonly used to treat feeding intolerance in preterm infants. The most widely used prokinetics are metocloperamide, cisapride, and domperidone.…”

mentioning

confidence: 99%

“…This macrolide has a motilin-like effect and stimulates peristalsis. 1,5 Erythromycin works as a motiline agent, by binding to the motiline receptor at the antrum and upper duodenum and leading to increased contractions in the antrum. 4,6 The motiline hormone stimulates the gastric emptying process and induces phase III of migrating motor complexes (MMC) in the proximal intestine, reducing transit time in the intestine.…”

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Efficacy of oral erythromycin to enhance feeding tolerance in preterm infants

Sukmawati

Rohsiswatmo

Suradi

et al. 2017

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Background Feeding intolerance is a common condition that affects preterm infants. Erythromycin is a prokinetic agent used to treat feeding intolerance, but its efficacy remains inconclusive. Objective To evaluate the effectiveness of oral erythromycin to enhance feeding tolerance in preterm infants. Methods This prospective, randomized controlled trial in preterm infants was conducted at Sanglah Hospital, Denpasar, Bali, from June 2015 to January 2016. Eligible infants were randomized to receive either 12.5 mg/kg/dose oral erythromycin or a placebo, every 8 hours. The primary outcome was the time to establish full enteral feeding. The secondary outcomes were body weight at full enteral feeding and length of hospital stay. Results Of 62 initial subjects, 3 infants dropped out of the study. Thirty infants were given erythromycin and 29 infants were given placebo. The baseline characteristics of the two groups were similar, with mean of gestational ages of 31.4 (SD 1.7) weeks in the erythromycin group and 32.4 (SD 2.2) weeks in the placebo group. The median times to reach full enteral feeding did not significantly differ between the two groups, with 10 (SD 5.3) days in the erythromycin group vs. 8 (SD 6.5) days in the placebo group (P=0.345). Also, median body weights at full enteral feeding and lengths of hospital stay were not significantly different between the two groups. Conclusion Erythromycin of 12.5 mg/kg/dose every 8 hours as prophylactic treatment does not significantly enhance feeding tolerance in preterm infants. Median body weights at full enteral feeding and length of hospital stay are not significantly different between the erythromycin and placebo groups. [Paediatr Indones. 2017;57:154-9 doi: http://dx

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Erythromycin and feeding intolerance in premature infants: a randomized trial

Cited by 41 publications

References 16 publications

Use of Oral Erythromycin for the Treatment of Gastrointestinal Dysmotility in Preterm Infants

Use of Oral Erythromycin for the Treatment of Gastrointestinal Dysmotility in Preterm Infants

A controlled trial of erythromycin and UDCA in premature infants during parenteral nutrition in minimizing feeding intolerance and liver function abnormalities

Efficacy of oral erythromycin to enhance feeding tolerance in preterm infants

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