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

Eur J Pediatr. 2019 Mar;178(3):301-314. doi: 10.1007/s00431-018-3287-7. Epub 2018 Nov 23.


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.

Keywords: Chemotherapy; Erythromycin; Hypertrophic pyloric stenosis; Infancy; Macrolides; Meta-analysis; Systematic review.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Anti-Bacterial Agents / adverse effects*
  • Breast Feeding
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Macrolides / adverse effects*
  • Pregnancy
  • Prenatal Exposure Delayed Effects / chemically induced
  • Pyloric Stenosis, Hypertrophic / chemically induced*
  • Risk Factors


  • Anti-Bacterial Agents
  • Macrolides