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

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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.

Author information

Author notes

  1. Mohammed Abdellatif and Sherief Ghozy contributed equally to this work.

Authors and Affiliations

  1. Neonatal Intensive Care Unit, Al-Adan hospital, Ministry of Health, Hadiya, Kuwait

    Mohammed Abdellatif

  2. Online Research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan

    Mohammed Abdellatif, Sherief Ghozy, Mohamed Gomaa Kamel, Sameh Samir Elawady, Mohamed Mohy Eldeen Ghorab, Andrew Wassef Attia, Truong Thi Le Huyen & Diep Trong Vien Duy

  3. Neurosurgery Department, El Sheikh Zayed Specialized Hospital, Giza, 41516, Egypt

    Sherief Ghozy

  4. Faculty of Medicine, Minia University, Minia, 61519, Egypt

    Mohamed Gomaa Kamel

  5. Faculty of Medicine, Tanta University, Tanta, 31527, Egypt

    Sameh Samir Elawady

  6. Faculty of Medicine, Alexandria University, Alexandria, 21111, Egypt

    Mohamed Mohy Eldeen Ghorab

  7. Ain Shams University Hospital, Cairo, 11633, Egypt

    Andrew Wassef Attia

  8. University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam

    Truong Thi Le Huyen & Diep Trong Vien Duy

  9. Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan

    Kenji Hirayama

  10. Evidence Based Medicine Research Group & Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam

    Nguyen Tien Huy

  11. Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan

    Nguyen Tien Huy

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  1. Mohammed Abdellatif
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  2. Sherief Ghozy
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  7. Truong Thi Le Huyen
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  8. Diep Trong Vien Duy
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  9. Kenji Hirayama
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  10. Nguyen Tien Huy
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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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Additional information

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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  • DOI: https://doi.org/10.1007/s00431-018-3287-7

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