Prokinetic drug therapy in children: a review of current options.
OBJECTIVE
To review the pharmacology, safety, and efficacy of the prokinetic agents metoclopramide and erythromycin in children.


METHODS
English-language literature was accessed using MEDLINE (1970-June 2004) with metoclopramide, erythromycin, macrolides, gastroesophageal reflux, and gastrointestinal motility as the search terms.


METHODS
Abstracts and original research articles were included. Preference was given to published controlled trials. Articles providing descriptions of pharmacology, safety, and effectiveness of metoclopramide and erythromycin for the treatment of gastroesophageal reflux (GER) were also used in this review.


RESULTS
Some authors advocate using a prokinetic agent along with acid suppression for treatment of GER in children. The 2 prokinetic agents most commonly used are erythromycin and metoclopramide. Erythromycin has numerous observational reports and controlled trials demonstrating its efficacy in improving feeding tolerance in children. Adverse drug reactions associated with its use were uncommon in prospective controlled trials. Few data support the use of metoclopramide for management of GER, and the potential adverse effects associated with its use need to be considered before prescribing.


CONCLUSIONS
The literature supports the use of erythromycin as a prokinetic agent. Many children with GER are adequately controlled with acid suppression alone; however, if use of a prokinetic agent is warranted, erythromycin in combination with acid suppression should be considered. Given the lack of prospective controlled studies demonstrating metoclopramide's efficacy and safety in the treatment of GER in children, metoclopramide should not be considered a treatment option.
Chicella
Michael F
MF
Department of Pharmacy, Children's Hospital of The King's Daughters, Norfolk, VA 23507-1910, USA. Chicelmf@chkd.org
Batres
L Arturo
LA
Heesters
Michael S
MS
Dice
James E
JE
D002648:Child; D018849:Controlled Clinical Trials as Topic / Q000379:methods; D004917:Erythromycin / Q000009:adverse effects / Q000627:therapeutic use*; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D008787:Metoclopramide / Q000009:adverse effects / Q000627:therapeutic use*
D004917:Erythromycin; D008787:Metoclopramide