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

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.

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Abbreviations

CI:

confidence interval

GHL:

Global Health Library

IHPS:

infantile hypertrophic pyloric stenosis

NIH:

National Institute of Health

NYAM:

New York Academy of Medicine

OR:

odds ratio

RR:

rate ratio

SD:

standard deviation

SIGLE:

System for Information on Grey Literature in Europe

VHL:

Virtual Health Library

WHO:

World Health Organization

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Funding

This study was conducted in part at the Joint Usage/Research Center on Tropical Disease, Institute of Tropical Medicine, Nagasaki University.

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Authors

Contributions

MA was responsible for the idea and study design. MA, MG, AWA, TTLH, DTVD, and NTH determined the inclusion and exclusion criteria. MA, MGK, SG, SSE, MG, AWA, TTLH, and DTVD screened the articles and extracted the data. M.G.K. and N.T.H. analyzed the data and interpreted it. All authors reviewed the paper and approved the final manuscript.

Corresponding author

Correspondence to Nguyen Tien Huy.

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The authors declare that they have no conflict of interest.

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Not Applicable.

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Communicated by Peter de Winter

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Abdellatif, M., Ghozy, S., Kamel, M.G. et al. Association between exposure to macrolides and the development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis. Eur J Pediatr 178, 301–314 (2019). https://doi.org/10.1007/s00431-018-3287-7

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Keywords

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