Is Azithromycin compatible with breastfeeding? Do we have alternatives for Azithromycin?

Azithromycin

March 3, 2018 (Very Low Risk)

Macrolide with actions and uses similar to those of erythromycin.
Oral administration once a day.

Excreted in very low levels into breast milk (Sutton 2015, Salman 2015, Kelsey 1994) and no problems have been observed in infants whose mothers have taken it (Goldstein 2009).

Commonly used for pediatric treatment.

Expert authors consider Azithromycin compatible with breastfeeding (Butler 2014, Kong 2013, Khrianin 2010, Chen 2010, Goldstein 2009, Mahadevan 2006, Bar-Oz 2003, Chin 2001).

Early exposition (first 15 days of life) to Macrolides (mostly Erythromycin) have been related to hypertrophic pyloric stenosis ( Lund 2014, Maheshwai 2007, Sørensen 2003), but not others, and less for Azithromycin (Goldstein 2009, Maheshwai 2007).

Be aware of false negative bacterial cultures in the infant when the mother is on antibiotics. Also, diarrheal disease due to imbalance of intestinal flora is possible.


See below the information of this related product:

Alternatives

We do not have alternatives for Azithromycin since it is relatively safe.

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Writings

  • Αζιθρομυκίνη (Greek)
  • أزيثروميسين (Arabic)
  • Азитромицин (Cyrillic)
  • 阿奇霉素 (Chinese)
  • アジスロマイシン (Japanese)
  • C38 H72 N2 O12,2H2O (Molecular formula)
  • 9-Deoxo-9a-aza-9a-methyl-9a-homoerythromycin A dihydrate (Chemical name)
  • J01FA10; S01AA26 (ATC Code/s)

References

  1. Sutton AL, Acosta EP, Larson KB, Kerstner-Wood CD, Tita AT, Biggio JR. Perinatal pharmacokinetics of azithromycin for cesarean prophylaxis. Am J Obstet Gynecol. 2015Abstract Full text (link to original source) Full text (in our servers)
  2. Salman S, Davis TM, Page-Sharp M, Camara B, Oluwalana C, Bojang A, D'Alessandro U, Roca A. Pharmacokinetics of Transfer of Azithromycin into the Breast Milk of African Mothers. Antimicrob Agents Chemother. 2015Abstract
  3. Lund M, Pasternak B, Davidsen RB, Feenstra B, Krogh C, Diaz LJ, Wohlfahrt J, Melbye M. Use of macrolides in mother and child and risk of infantile hypertrophic pyloric stenosis: nationwide cohort study. BMJ. 2014Abstract Full text (link to original source) Full text (in our servers)
  4. Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: Part II. Lactation. J Am Acad Dermatol. 2014Abstract
  5. Kong YL, Tey HL. Treatment of acne vulgaris during pregnancy and lactation. Drugs. 2013Abstract
  6. Khrianin AA, Reshetnikov OV. [Use of macrolides in pregnancy and lactation according to evidence-based medicine: pro et contra]. Antibiot Khimioter. 2010Abstract
  7. Chen LH, Zeind C, Mackell S, LaPointe T, Mutsch M, Wilson ME. Breastfeeding travelers: precautions and recommendations. J Travel Med. 2010Abstract Full text (link to original source) Full text (in our servers)
  8. Goldstein LH, Berlin M, Tsur L, Bortnik O, Binyamini L, Berkovitch M. The safety of macrolides during lactation. Breastfeed Med. 2009Abstract
  9. Maheshwai N. Are young infants treated with erythromycin at risk for developing hypertrophic pyloric stenosis? Arch Dis Child. 2007Abstract Full text (link to original source) Full text (in our servers)
  10. Mahadevan U, Kane S. American gastroenterological association institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology. 2006Abstract Full text (link to original source) Full text (in our servers)
  11. Bar-Oz B, Bulkowstein M, Benyamini L, Greenberg R, Soriano I, Zimmerman D, Bortnik O, Berkovitch M. Use of antibiotic and analgesic drugs during lactation. Drug Saf. 2003Abstract
  12. Sørensen HT, Skriver MV, Pedersen L, Larsen H, Ebbesen F, Schønheyder HC. Risk of infantile hypertrophic pyloric stenosis after maternal postnatal use of macrolides. Scand J Infect Dis. 2003Abstract
  13. Chin KG, McPherson CE 3rd, Hoffman M, Kuchta A, Mactal-Haaf C. Use of anti-infective agents during lactation: Part 2--Aminoglycosides, macrolides, quinolones, sulfonamides, trimethoprim, tetracyclines, chloramphenicol, clindamycin, and metronidazole. J Hum Lact. 2001Abstract
  14. Kelsey JJ, Moser LR, Jennings JC, Munger MA. Presence of azithromycin breast milk concentrations: a case report. Am J Obstet Gynecol. 1994Abstract
  15. Fulton B, Moore LL. Antiinfectives in breastmilk. Part II: Sulfonamides, tetracyclines, macrolides, aminoglycosides and antimalarials. J Hum Lact. 1992Abstract
  16. Periti P, Mazzei T, Mini E, Novelli A. Clinical pharmacokinetic properties of the macrolide antibiotics. Effects of age and various pathophysiological states (Part I). Clin Pharmacokinet. 1989Abstract