title: Post-natal erythromycin exposure and risk of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Macrolide antibiotics, erythromycin, in particular, have been linked to the development of infantile hypertrophic pyloric stenosis (IHPS). Our aim was to conduct a systematic review of the evidence of whether post-natal erythromycin exposure is associated with subsequent development of IHPS.
  
  
  METHODS
  A systematic review of postnatal erythromycin administration and IHPS was performed. Papers were included if data were available on development (yes/no) of IHPS in infants exposed/unexposed to erythromycin. Data were meta-analysed using Review Manager 5.3. A random effects model was decided on a priori due to heterogeneity of study design; data are odds ratio (OR) with 95 % CI.
  
  
  RESULTS
  Nine papers reported data suitable for analysis; two randomised controlled trials and seven retrospective studies. Overall, erythromycin exposure was significantly associated with development of IHPS [OR 2.45 (1.12-5.35), p = 0.02]. However, significant heterogeneity existed between the studies (I2= 84 %, p < 0.0001). Data on erythromycin exposure in the first 14 days of life was extracted from 4/9 studies and identified a strong association between erythromycin exposure and subsequent development IHPS [OR 12.89 (7.67-2167), p < 0.00001].
  
  
  CONCLUSIONS
  This study demonstrates a significant association between post-natal erythromycin exposure and development of IHPS, which seems stronger when exposure occurs in the first 2 weeks of life.
authors.affiliation: Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.|Great Ormond Street Hospital for Children, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Murchison
authors.affiliation: Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.|Great Ormond Street Hospital for Children, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: De Coppi
authors.affiliation: Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK. s.eaton@ucl.ac.uk.|Great Ormond Street Hospital for Children, London, UK. s.eaton@ucl.ac.uk.
authors.forename: S
authors.initials: S
authors.lastname: Eaton
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D004917:Erythromycin / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D046248:Pyloric Stenosis, Hypertrophic / Q000139:chemically induced*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D004917:Erythromycin
keywords: Erythromycin; Macrolide antibiotics; Pyloric stenosis