From the Guidelines
Erythromycin is recommended for short-term use in treating gastrointestinal dysmotility in premature infants due to its effectiveness as a motilin receptor agonist, despite the risk of tachyphylaxis 1.
Key Considerations
- The medication should be used at a dose of 3-12.5 mg/kg/dose given orally every 6 hours, with severe cases potentially starting at the higher end of this range.
- Treatment typically continues for 2-4 weeks, with potential tapering as symptoms improve.
- Erythromycin helps reduce feeding intolerance, decrease gastric residuals, and may shorten the time to full enteral feeding in preterm infants.
Monitoring and Precautions
- When administering erythromycin, monitor for potential side effects including cardiac arrhythmias (particularly QT prolongation), pyloric stenosis (especially in infants under 2 weeks of age), and antibiotic-associated diarrhea.
- Lower doses (3-5 mg/kg/dose) are often used for prokinetic effects, while higher doses provide both prokinetic and antibiotic effects.
- Consider starting with a lower dose and titrating up if needed, and always ensure the medication is given at least 30 minutes before feeding to maximize its prokinetic effect.
Evidence Basis
- The most recent and highest quality study 1 supports the use of erythromycin for short-term treatment of gastrointestinal dysmotility, despite its limitations due to tachyphylaxis.
- Other studies 1 provide additional context on the management of gastrointestinal motility disorders, but the primary recommendation is based on the most recent evidence 1.
From the Research
Erythromycin Use in Preemies for Dysmotility
- Erythromycin has been studied as a prokinetic agent for the treatment of gastrointestinal dysmotility in preterm infants, with some studies showing its effectiveness in facilitating enteral feeding 2, 3, 4.
- A randomized controlled trial found that oral erythromycin significantly shortened the time to establish half, three-quarters, and full enteral feeding in preterm very low birthweight infants with moderately severe gastrointestinal dysmotility 2.
- Another study found that erythromycin appeared to be equally effective when given orally or intravenously, with no serious adverse effects reported 3.
- However, other studies have reported conflicting findings, with some suggesting that low-dose regimes or prophylactic trials may not be useful 5, 6.
- High-dose regimes used as rescue therapy in infants with established gastrointestinal dysmotility have consistently shown clinical benefit, including a shorter time to attain full enteral feeding and a decrease in the duration of requirement for parenteral nutrition 5, 6.
- The use of erythromycin in preterm infants should be done cautiously and selectively, as long-term outcomes have not been fully evaluated and there are theoretical risks of prolonged antibiotic use, such as emergence of antibiotic resistance and abnormal intestinal microbiota 5, 6.