Azithromycin and Erythromycin Have Comparable Effectiveness for Pediatric Antroduodenal Motility Disorders

Researchers compared the effectiveness and safety of azithromycin and erythromycin in pediatric patients with antroduodenal motility disorders.

Azithromycin is an acceptable alternative to erythromycin for the treatment of antroduodenal motility disorders in children, researchers reported in the Journal of Pediatric Gastroenterology and Nutrition.

The study compared the effectiveness and safety of azithromycin and erythromycin in pediatric patients who underwent antroduodenal manometry (ADM) at a children’s hospital from 2013 to 2017.

A total of 51 patients were included — 21 patients received azithromycin and 30 received erythromycin. The participants had a mean age of 9.7±5.4 years and mean weight of 35.4±23.5 kg. The erythromycin group had a higher proportion of girls than the azithromycin group (76.7% vs 38.1%, respectively; P =.009).

The median lag time from infusion initiation to the start of contractile activity was 10 minutes in the erythromycin group (95% CI, 10.5-16.4) and 10 minutes in the azithromycin group (95% CI, 8.0-12.0); the difference between 2 groups was not statistically significant. The median dose of erythromycin was 2.33 mg/kg (95% CI, 2.08-2.65) and the median dose of azithromycin was 3.97 mg/kg (95% CI, 3.0-5.0).

All patients developed a robust contractile response in the antrum and duodenum compared with baseline after receiving either medication.

For participants who received azithromycin, the mean area under the curve (AUC) across all pressure ports increased from 1670 (95% CI, 1110-2250) to 10,810 (95% CI, 5590-11,520) mmHg × s (P <.001). The mean motility index increased from 8.63 (95% CI, 7.87-9.42) to 11.79 (95% CI, 11.03-12.21) (P <.001).

The mean AUC for erythromycin increased from 2260 (95% CI, 1590-2600) to 8740 (95% CI, 5880-11,760) mmHg × s (P <.001). The mean motility index for erythromycin increased from 8.63 (95% CI, 7.87-9.42) to 11.98 (95% CI, 11.2-12.21) (P <.001).

Antroduodenal migrating motor complex (MMC) phase III was observed in all patients after macrolide stimulation, regardless of the type of macrolide received. No statistical difference was observed in the AUC or motility index after azithromycin or erythromycin infusion in either the antrum or duodenum.

Overall, 31 patients had mild side effects after prokinetic infusion. Of the cohort, 17 patients had abdominal pain during prokinetic infusion — 6 (28.6%) in the azithromycin group and 11 (36.7%) in the erythromycin group (P =.696).

Study limitations include the retrospective, nonrandomized design, as well as failure to prospectively follow patients for long-term efficacy and toxicity outcomes. In addition, the prokinetic effects observed with azithromycin may not be generalizable to patients with intestinal pseudo-obstruction without MMC phase III.

“Azithromycin is a safe and effective prokinetic for pediatric patients,” the researchers concluded. “It has comparable pharmacodynamic effectiveness to the conventional motilin agonist erythromycin with potentially fewer side effects.”


Mougey EB, Saunders M, Franciosi JP, Gomez-Suarez RA. Comparative effectiveness of intravenous azithromycin versus erythromycin stimulating antroduodenal motility in children. J Pediatr Gastroenterol Nutr. 2022;74(1):25-32. doi: 10.1097/MPG.0000000000003271