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Can erythromycin be used as a prokinetics in premature babies with food intolerance?

A new systematic review by the Cochrane Neonatal Collaborative Review Group focuses on the use of erythromycin as a prokinetics in premature babies.

The functional immaturity of the gastrointestinal tract and, above all, its motor activity in premature babies predispose to food intolerance. Motiline, a gastrointestinal peptide, stimulates the prokinetic activity of the gastrointestinal tract. Erythromycin in small doses (1 to 3 mg / kg), as a motilin agonist, improves the prokinetic effect.

The aim of the review was to discover the efficacy of erythromycin as an activator of the motor activity of the gastrointestinal tract in premature infants suffering from food intolerance and to evaluate the clinically significant drug adverse effects associated the use of erythromycin. The review included randomized controlled trials of oral or parenteral (iv) administration of erythromycin at a dose of 3 to 12 mg / kg / day in premature infants (gestational age less than 36 weeks) with food intolerance. Two randomized controlled trials of the efficacy of erythromycin in premature babies have been identified to improve gastrointestinal motility. In both studies, erythromycin was used in doses above 12 mg / kg / day and no statistically significant change was observed in the enteric digestion process. Thus, there is no evidence of the effectiveness of erythromycin at antibacterial doses in premature infants with food intolerance. Further studies are required to obtain reliable evidence of the efficacy (or ineffectiveness) of using erythromycin in small doses as a prokinetics in premature infants.