Evaluating the Efficacy and Safety of Erythromycin for the Treatment of Gastroparesis in Infants and Children.

Abstract

Objectives: Erythromycin has been utilized for gastroparesis and feeding intolerance in adults and neonates, but limited studies exist for infants and children. The purpose of this study was to evaluate the safety and efficacy of erythromycin for gastroparesis in pediatric patients. The primary objective was to identify the number of patients with gastroparesis improvement, defined as no additional use of promotility agents, no erythromycin dose increases or need for other interventions (transpyloric or gastrostomy-jejunostomy tube). Secondary objectives included comparisons of clinical characteristics and outcomes between those with and without gastroparesis improvement and identification of patients with QTc prolongation following erythromycin initiation (QTc interval >450 ms or ≥25% increase from baseline).

Methods: This retrospective study included patients >28 days to <18 years of age receiving erythromycin for gastroparesis for ≥48 hours between August 1, 2019 to August 31, 2022. Comparisons were performed using Wilcoxon 2-sample test, χ², or Fisher exact tests.

Results: Gastroparesis improvement was noted in 40 (59.7%) of 67 included patients. Patients without improvement were significantly younger than those with improvement, median (IQR) 2 (1.0-3.0) vs 3.5 (1.5-6.5) years, respectively (p = 0.038). Patients with improvement had a significantly shorter treatment duration than those with no improvement, 4 (3-8) vs 9 (5-19) days (p = 0.01). Of the 37 patients who had an electrocardiogram obtained, 4 patients (10.8%) had QTc prolongation but did not develop dysrhythmias.

Conclusions: The majority had gastroparesis improvement with erythromycin therapy. Those without improvement were younger and had a longer erythromycin treatment course. QTc prolongation occurred in 4 patients; no dysrhythmias were noted.