מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – Administration of systemic erythromycin to infants, particularly during the first 2 weeks of life, appears to increase the risk of infantile hypertrophic pyloric stenosis (IHPS), according to physicians from the Indiana University School of Medicine in Indianapolis.
Dr. Barbara E. Mahon and associates took advantage of a comprehensive electronic medical records system of a large urban hospital to identify close to 15,000 eligible infants born between 1993 and 1999. As reported in the Journal of Pediatrics for September, systemic erythromycin was prescribed for 469. IHPS was diagnosed in 43.
Six of 226 infants who received erythromycin at no more than 2 weeks of age developed IHPS, compared with 37 of 14,650 who did not. The investigators calculated a relative risk of 10.51 for those prescribed erythromycin compared with their counterparts. IHPS did not develop in any of the 243 infants who received erythromycin after 2 weeks of age.
Prescriptions for 14 days or longer were associated with a significantly greater risk of IHPS than those for less than 14 days (p < 0.05). Among 1243 infants prescribed erythromycin ophthalmic ointment, there was no increased risk of IHPS.
Dr. Mahon's group suggests that erythromycin's propensity to cause "strong, nonpropagated gastric contractions" may play a role in pyloric hypertrophy. Based on their findings, the authors estimate that 42 infants would need to be treated with erythromycin during the first 2 weeks of age to cause one additional case of IHPS.
"The age at which babies presented with pyloric stenosis was in the 1- to 3-month range," Dr. Mahon told Reuters Health. "There were no babies who presented beyond 3 months of age. So I think until the baby is out of this age range, there should be a concern. But that concern is a whole lot less after the baby is 3 months old."
She added that physicians need to think about the indication for which erythromycin would be prescribed and whether there is an alternative.
"One of the things I'm interested in looking at is alternatives for babies who are exposed to Chlamydia," Dr. Mahon commented. "Azithromycin comes to mind, because it's not a motilin agonist. However, it's also not approved for infants below the age of 6 months. So we can't recommend it at this point, but it would be worth studying."
The research team recommends that when erythromycin is used, it be prescribed for the shortest effective duration. Parents of babies treated with erythromycin should be counseled regarding the risk and symptoms of IHPS, they add.
e-Med Tools
קצר קולע וממוקד
e-Med סמינרים
אי-מד תחקירים
Medscape Tools
Journal Club
מרכזי מידע ושירות
Facebook
מידע למפרסם
מאגר תרופות
אינדקס שימושי
חדשות משה"ב
eMed HealthClub
מחקרים קליניים
השאירו תגובה
רוצה להצטרף לדיון?תרגישו חופשי לתרום!