Erythromycin has a prokinetic activity if it is administered intravenously. Systemic administration of erythromycin in young infants increases the risk of the infants developing hypertrophic pyloric stenosis.113 Similarly, a possible association exists with maternal macrolide therapy in late pregnancy.113 Intravenous erythromycin is reported to cause QT prolongation and ventricular fibrillation.97,114 The use of erythromycin at doses far below the concentrations necessary for an inhibitory effect on susceptible bacteria provides close to ideal conditions for the induction of bacterial mutation and selection.115 Emergence of bacteria increasingly resistant to macrolide antibiotics has been reported.116 New erythromycin-like molecules without the antibiotic properties are in development.
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