Is Chloramphenicol (topical use) compatible with breastfeeding? Do we have alternatives for Chloramphenicol (topical use)?

Chloramphenicol (topical use)

February 26, 2018 (Low Risk)

Topically used to treat cutaneous, eye and ear infections.

The small dose used and poor plasma uptake of most topical ophthalmic and dermal preparations make it very unlikely that a significant amount would pass into breast milk.
Plasma levels after topical application on skin are 1000 times lower than those observed after systemic administration (Fluhr 1998).
Possible absorption following ophthalmologic administration could be minimized by following appropriate ophthalmologist instructions (eg finger-compression on the tear sac at the internal eye’s corner for one minute after application of drops)
Even after been taken systemically (orally or parenterally), the excretion into breastmilk is poor, which would impede the development of neonatal gray syndrome.

Do not apply on the chest to prevent the infant from ingesting it. Otherwise, apply it after a breast feeding and clean it up thoroughly with water before the next feeding.

Alternatives

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.

Drug trade names

References

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  2. 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
  3. Fluhr JW, Gloor M, Merkel W, Warnecke J, Höffler U, Lehmacher W, Glutsch J. Antibacterial and sebosuppressive efficacy of a combination of chloramphenicol and pale sulfonated shale oil. Multicentre, randomized, vehicle-controlled, double-blind study on 91 acne patients with acne papulopustulosa (Plewig and Kligman's grade II-III). Arzneimittelforschung. 1998Abstract
  4. Zhang Y, Zhang Q, Xu Z. [Tissue and body fluid distribution of antibacterial agents in pregnant and lactating women]. Zhonghua Fu Chan Ke Za Zhi. 1997Abstract
  5. Matsuda S. Transfer of antibiotics into maternal milk. Biol Res Pregnancy Perinatol. 1984Abstract
  6. Plomp TA, Thiery M, Maes RA. The passage of thiamphenicol and chloramphenicol into human milk after single and repeated oral administration. Vet Hum Toxicol. 1983Abstract
  7. Burke JT, Wargin WA, Sherertz RJ, Sanders KL, Blum MR, Sarubbi FA. Pharmacokinetics of intravenous chloramphenicol sodium succinate in adult patients with normal renal and hepatic function. J Pharmacokinet Biopharm. 1982Abstract
  8. Nahata MC, Powell DA. Bioavailability and clearance of chloramphenicol after intravenous chloramphenicol succinate. Clin Pharmacol Ther. 1981Abstract
  9. Abrams SM, Degnan TJ, Vinciguerra V. Marrow aplasia following topical application of chloramphenicol eye ointment. Arch Intern Med. 1980Abstract
  10. Trope GE, Lawrence JR, Hind VM, Bunney J. Systemic absorption of topically applied chloramphenicol eyedrops. Br J Ophthalmol. 1979Abstract
  11. Koup JR, Lau AH, Brodsky B, Slaughter RL. Chloramphenicol pharmacokinetics in hospitalized patients. Antimicrob Agents Chemother. 1979Abstract Full text (link to original source) Full text (in our servers)
  12. Havelka J, Hejzlar M, Popov V, Viktorinová D, Procházka J. Excretion of chloramphenicol in human milk. Chemotherapy. 1968Abstract