Erythromycin improves gastrointestinal motility in extremely low birthweight infants

Abstract

Key wordsErythromycin (EM) was administered to five extremely low birthweight infants (ELBWI) with delayed enteral feeding to evaluate the clinical effect on severely impaired gastrointestinal motility. Five patients studied responded well to EM administration without any adverse effects during the course. Four patients were given 15-30 mg/kg per day EM intravenously as a loading and thereafter 3-5 mg/kg per day as a maintenance dose. One patient responded well without loading. The infants could be fed enterally 4,5,6, 4 and 2 days after the initiation of EM administration, respectively. Erythromycin administration is a safe and useful way to facilitate gastrointestinal motility in ELBWI who require prolonged ventilator

Randomised controlled study of oral erythromycin for treatment of gastrointestinal dysmotility in preterm infants

“…As the safety dose limit of intravenous erythromycin in preterm infants has not yet been determined,23 administration by this route is best avoided. With regard to the dose of oral erythromycin, we opted to use a slightly higher dose (12.5 mg/kg/dose) than the lower dose regimen (3–5 mg/kg/dose)14 15 commonly used for the management of gastrointestinal dysmotility because: ( a ) our previous success in treatment of severe gastrointestinal dysmotility in preterm infants indicated that the higher dosage was effective13; ( b ) former studies using a lower dose regimen often required large intravenous loading doses of erythromycin (15–30 mg/kg/day) for the initial few days of treatment14 15; ( c ) the serum drug concentration achieved by oral medication is likely to be lower than that achieved by the intravenous route20-22; ( d ) larger doses of erythromycin have also been shown to facilitate gastric emptying by stimulating postprandial antroduodenal motor activity 24. Infants allocated to receive active drug were given oral erythromycin (Ery-Ped; erythromycin ethyl succinate diluted to 12.5 mg/ml with sterile water; Abbott Laboratories, Abbott Park, Illinois, USA) 12.5 mg/kg, every six hours.…”

Efficacy of oral erythromycin for treatment of feeding intolerance in preterm infants

“…Incidentally, most studies of low-dose intravenous EM used doses of 1 to 3 mg/kg, which are presumably equivalent to oral EM ethyl succinate doses of 2 to 6 mg/kg. 8,16,17 Finally, in studies using low-dose intravenous EM, an EM loading dose of 15 to 30 mg/kg/day was given for the initial few days to ensure adequate blood level of EM. 8,16 Thus, we chose an arbitrary loading dose of 40 mg/kg/day for the first 2 days.…”

“…8,16,17 Finally, in studies using low-dose intravenous EM, an EM loading dose of 15 to 30 mg/kg/day was given for the initial few days to ensure adequate blood level of EM. 8,16 Thus, we chose an arbitrary loading dose of 40 mg/kg/day for the first 2 days. Our regimen of oral EM ethyl succinate was tested in a pilot study of 10 preterm infants and determined to be safe.…”

Erythromycin and feeding intolerance in premature infants: a randomized trial

“…It has been used in the treatment of gastrointestinal dysmotility in adults and children. [4][5][6] Evidence for its use in neonates is conflicting. 7 The objective of this prospective, double-blinded, placebo-controlled randomized trial was to evaluate the effectiveness of erythromycin as a prokinetic drug in promoting gastrointestinal motility in preterm infants with feeding intolerance.…”