Erythromycin as a prokinetic agent in preterm infants

Background: The macrolide antibiotic erythromycin is a prokinetic agent that stimulates gastrointestinal motility. The aim of the study was to determine the effect of erythromycin on the Gastrointestinal motility of preterm infants. Methods: Erythromycin 10 mg/kg, 8 hourly or a placebo, was Given orally for 7 days in a double-blind randomized, crossover study of 20 preterm infants with a median gestational age of 32 weeks (range, 26-34 weeks). Antral contractility was determined by using ultrasonography to measure the decrease in the gastric antral cross-sectional area after a feed. The whole Gut transit time was assessed by timing the transit of carmine red through the gut. Results: Antral contractility lasted for a shorter period of time during erythromycin treatment than during placebo treatment (mean [standard deviation], 31 minutes [9.9 minutes] vs. 70 minutes [13 minutes]: P < 0.01). Whole Gut transit time was also shorter during erythromycin treatment (mean, 23.1 hours [12.9 hours] vs. 49.3 hours [29 hours]; P < 0.01). All infants tolerated the drug well. Conclusions: Oral erythromycin in food-intolerant preterm infants enhances both antral contractility and whole gut transit time.