Association between exposure to macrolides and the development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis

We've known for years that Erythromycin and perhaps azithromycin can cause pyloric stenosis in infants,  but we were cautious about its use during breastfeeding, or during pregnancy in mothers.  Seems from this data that erythromycin used during pregnancy or breastfeeding may not be associated with pyloric stenosis.  This is probably dose-related, and perhaps time dependent,  since levels in milk are low. This is good news.  Thus women can potentially use macrolide antibiotics while breastfeeding.  I still think they are not the best choice early postpartum in breastfeeding mothers and physicians should choose an alternate, just in case the first few months postpartum. 


Eur J Pediatr. 2018 Nov 23. doi: 10.1007/s00431-018-3287-7. [Epub ahead of print]

Association between exposure to macrolides and the development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis.

Abdellatif M1,2, Ghozy S2,3, Kamel MG2,4, Elawady SS2,5, Ghorab MME2,6, Attia AW2,7, Le Huyen TT2,8, Duy DTV2,8, Hirayama K9, Huy NT10,11.

Abstract

Macrolides are bacteriostatic antibiotics with a broad spectrum of activity against Gram-positive bacteria. The aim of this study was to systematically review and meta-analyze the association between infantile hypertrophic pyloric stenosis (IHPS) and macrolides. Nine databases were searched systematically for studies with information on the association between macrolides and IHPS. We combined findings using random effects models. Our study revealed 18 articles investigating the association between macrolides and IHPS. There was a significant association between the development of IHPS and erythromycin (2.38, 1.06-5.39). The association was strong when erythromycin was used during the first 2 weeks of life (8.14, 4.29-15.45). During breastfeeding, use of macrolides showed no significant association with IHPS in infants (0.96, 0.61-1.53). IHPS was not associated with erythromycin (1.11, 0.9-1.36) or macrolides use during pregnancy (1.15, 0.98-1.36).Conclusions: There is an association between erythromycin use during infancy and developing IHPS in infants. However, no significant association was found between macrolides use during pregnancy or breastfeeding. Additional large studies are needed to further evaluate potential association with macrolide use. What is known? • Erythromycin intake in the first 2 weeks of life is associated with an increased risk of pyloric stenosis. What is New? • There is currently no evidence of significant association between macrolides use during pregnancy or breastfeeding and pyloric stenosis.

KEYWORDS:

Chemotherapy; Erythromycin; Hypertrophic pyloric stenosis; Infancy; Macrolides; Meta-analysis; Systematic review

PMID: 30470884