A 5-week-old infant is admitted to a high dependency unit with paroxysmal cough associated with dusky episodes. The severity and frequency of cough paroxysm increases and 48 h later pernasal swab confirms the diagnosis of pertusis. You want to treat the infant with erythromycin. However, you have heard that erythromycin can cause hypertrophic pyloric stenosis in young infants. So you decide to find out more before starting the treatment.

Structured clinical question

Are the young infants (subject) exposed to erythromycin (intervention) at risk for developing hypertrophic pyloric stenosis (outcome)?

Search strategy and outcome

Primary sources

Medline (1951–2006) via Dialog DATA star:

Keywords: erythromycin or maciolides AND pyloric stenosis or infantile hypertrophic pyloric stenosis.

Limits: Human, English.

Outcome

A total of 30 articles were found. All the abstracts were read and six relevant articles were identified for the analysis (table 1).^1–6 One systematic review included in the analysis was primarily designed to look at the use of erythromycin as a prokinetic agent in preterm infants.⁶ Another systemic review⁷ looking at the use of erythromycin for the same was read but not included …