Use and Safety of Erythromycin and Metoclopramide in Hospitalized Infants.

Abstract

OBJECTIVE:

Prokinetic medications are used in premature infants to promote motility and decrease time to full enteral feeding. Erythromycin and metoclopramide are the most commonly used prokinetic medications in the neonatal intensive care unit (NICU), but their safety profile is not well defined.

METHODS:

We conducted a large retrospective cohort study using data from 348 NICUs managed by the Pediatrix Medical Group. All of the infants exposed to ≥1 dose of erythromycin, metoclopramide, or both, from a cohort of 8,87,910 infants discharged between 1997 and 2012 were included. We collected laboratory and clinical information while infants were exposed to erythromycin or metoclopramide and described the frequency of laboratory abnormalities and clinical adverse events (AEs).

RESULTS:

Metoclopramide use increased from 1997 to 2005 and decreased from 2005 to 2012, whereas erythromycin use remained stable. Erythromycin use was most often associated with a diagnosis of feeding problem (40%), whereas metoclopramide was most often associated with a diagnosis of gastroesophageal reflux (59%). The most common laboratory AE during exposure to erythromycin or metoclopramide was hyperkalemia (8.6/1000 infant days on erythromycin and 11.0/1000 infant days on metoclopramide). Incidence of pyloric stenosis was greater with erythromycin than with metoclopramide (10/1095, 0.9% vs 76/19,001, 0.4%; P = 0.01), but odds were not significantly increased after adjusting for covariates (odds ratio 0.52, 95% confidence interval [CI] 0.26-1.02, P = 0.06). More infants experienced an AE while treated with metoclopramide than with erythromycin (odds ratio 1.21, 95% CI 1.03-1.43).

CONCLUSIONS:

Metoclopramide was associated with increased risk of AEs compared with erythromycin. Studies are needed to confirm safety and effectiveness of both the drugs in infants.

• Authors: Jessica E Ericson, Christopher Arnold, Jomani Cheeseman, Jordan Cho, Sarah Kaneko, Ele'na Wilson, Reese H Clark, Daniel K Benjamin Jr, Vivian Chu, P Brian Smith, Christoph P Hornik, Best Pharmaceuticals for Children Act–Pediatric Trials Network Administrative Core Committee
• Journal: Journal of pediatric gastroenterology and nutrition (J Pediatr Gastroenterol Nutr) Vol. 61 Issue 3 Pg. 334-9 (Sep 2015) ISSN: 1536-4801 [Electronic] United States
• PMID: 25806675 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Gastrointestinal Agents
• Erythromycin
• Metoclopramide

Topics

• Enteral Nutrition (adverse effects)
• Erythromycin (adverse effects, therapeutic use)
• Female
• Gastroesophageal Reflux (drug therapy)
• Gastrointestinal Agents (adverse effects, therapeutic use)
• Humans
• Hyperkalemia (chemically induced, epidemiology)
• Incidence
• Infant, Newborn
• Infant, Premature
• Infant, Premature, Diseases (drug therapy)
• Intensive Care Units, Neonatal (statistics & numerical data)
• Male
• Metoclopramide (adverse effects, therapeutic use)
• Pyloric Stenosis, Hypertrophic (chemically induced, epidemiology)
• Retrospective Studies