Vol. 9, Issue 2, Part C (2025)

Constipation is a prevalent gastrointestinal disorder among children, affecting approximately 10-30% of the pediatric population worldwide. It is associated with significant morbidity, including abdominal discomfort, fecal incontinence, and emotional distress, often leading to repeated healthcare visits and reduced quality of life. Although first-line management typically involves dietary modifications, behavioral interventions, and the use of osmotic or stimulant laxatives, a subset of patients fails to respond adequately to these conventional therapies. In such cases-particularly those involving delayed gastric emptying, functional constipation refractory to standard treatment, or neurogenic bowel dysfunction-alternative therapeutic strategies are required.

Erythromycin, a macrolide antibiotic with potent prokinetic properties mediated through stimulation of motilin receptors in the gastrointestinal tract, has been increasingly investigated as an adjunctive treatment for constipation in both adult and pediatric populations. Its ability to enhance gastrointestinal motility at low doses makes it a potentially attractive option in managing dysmotility-related constipation. However, its dual role as an antimicrobial agent raises concerns regarding the development of bacterial resistance when used chronically for non-infectious indications.

This systematic review summarizes the evidence base for erythromycin in the treatment of paediatric constipation. A thorough search was conducted across PubMed, Embase, Scopus and the Cochrane Library for relevant trials, observational studies and case series published from 2000 to 2024. The focus of this review was threefold with the primary outcome measuring frequency of bowel movements along with decreased symptoms of constipation and a global improvement in clinical outcomes. The secondary measures analysed the safety, adverse effects, tachyphylaxis and antibiotic resistance.

The review results found that erythromycin may be able to improve bowel frequency and reduce the symptoms of constipation on a short term basis with select children that is with documented motility disturbances. However long term effects remain unknown, possible diminishing therapeutic effect over time was contributed as ironically making its usage infrequent due to the risk of antibiotic resistance. Adverse effects were mainly mild contributing but in some cases were associated to gastrointestinal discomfort and rarec cases of arrhythmia due to QT prolongation.

We conclude that though some potential exists for erythromycin as a second line prokinetic agent in children who fail to respond to conventional treatments for constipation, it should only be specified for certain types of children in specific clinical situations and under medical supervision. Further need for quality RCT of adequate size with longer follow-up and standard assessment of outcomes need to be undertaken to identify what it place as a possible treatment, or aid in understanding what longer term side effect may exist on paediatrics.