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PEDIATRICS

Prokinetic Drug Therapy in Children: A Review of Current Options

Clinical Specialist—General Pediatrics, Department of Pharmacy, Children's Hospital of The King's Daughters; Assistant Professor, Pediatrics, Eastern Virginia Medical School, Norfolk, VA

L Arturo Batres, MD

Pediatric Gastroenterologist, Division of Pediatric Gastroenterology and Nutrition, Children's Hospital of The King's Daughters

Michael S Heesters, PharmD

at time of writing, Pharmacy Student, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA

James E Dice, PharmD

Director of Pharmacy, Department of Pharmacy, Children's Hospital of The King's Daughters

Reprints: Dr. Chicella, Department of Pharmacy, Children's Hospital of The King's Daughters, 601 Children's Ln., Norfolk, VA 23507-1910, fax 757/668-7482, Chicelmf{at}chkd.org

OBJECTIVE: To review the pharmacology, safety, and efficacy of the prokinetic agents metoclopramide and erythromycin in children.

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

STUDY SELECTION AND DATA EXTRACTION: 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.

DATA SYNTHESIS: 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.

Key Words: erythromycin, gastroesophageal reflux, gastrointestinal motility, metoclopramide, pediatrics

Published Online, March 8, 2005. www.theannals.com, DOI 10.1345/aph.1E411

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-05-014-H01

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