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

Erythromycin

August 2, 2016 (Low Risk)

Excreted in very low levels into breast milk.

Commonly used for pediatric treatment of small babies; it is very well tolerated by infants.

Erythromycin is a macrolide that has been related to hypertrophic pyloric stenosis after early exposition through the breast milk. Avoiding its use in the first post-partum month would be a cautious measure.

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

Small doses used for treatment of dermatologic and ophthalmologic conditions, together with a very low level in the mother’s plasma make very unlikely a significant excretion into breast milk.

Topically used Erythromycin is safe while breastfeeding. Systemic treatments would be safer after the first month of life.

The American Academy of Pediatrics rates it usually compatible with breastfeeding.

List of Essential Medicines WHO 2002: Compatible with breastfeeding.

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.

Writings

  • Ερυθρομυκίνη (Greek)
  • Эритромицин (Cyrillic)
  • 红霉素 (Chinese)
  • エリスロマイシン (Japanese)

References

  1. Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: Part II. Lactation. J Am Acad Dermatol. 2014Abstract
  2. Kong YL, Tey HL. Treatment of acne vulgaris during pregnancy and lactation. Drugs. 2013Abstract
  3. ASGE Standard of Practice Committee, Shergill AK, Ben-Menachem T, Chandrasekhara V, Chathadi K, Decker GA, Evans JA, Early DS, Fanelli RD, Fisher DA, Foley KQ, Fukami N, Hwang JH, Jain R, Jue TL, Khan KM, Lightdale J, Pasha SF, Sharaf RN, Dominitz JA, Cash BD. Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc. 2012Abstract Full text (link to original source) Full text (in our servers)
  4. Goldstein LH, Berlin M, Tsur L, Bortnik O, Binyamini L, Berkovitch M. The safety of macrolides during lactation. Breastfeed Med. 2009Abstract
  5. Ng PC. Use of oral erythromycin for the treatment of gastrointestinal dysmotility in preterm infants. Neonatology. 2009Abstract Full text (in our servers)
  6. 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)
  7. 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
  8. 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
  9. Noti A, Grob K, Biedermann M, Deiss U, Brüschweiler BJ. Exposure of babies to C15-C45 mineral paraffins from human milk and breast salves. Regul Toxicol Pharmacol. 2003Abstract
  10. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  11. [No authors listed] Erythromycin-induced pyloric stenosis in infants. Prescrire Int. 2001Abstract
  12. 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
  13. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001Abstract Full text (link to original source) Full text (in our servers)
  14. van Hoogdalem EJ. Transdermal absorption of topical anti-acne agents in man; review of clinical pharmacokinetic data. J Eur Acad Dermatol Venereol. 1998Abstract
  15. 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
  16. Ito S, Blajchman A, Stephenson M, Eliopoulos C, Koren G. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993Abstract
  17. Fulton B, Moore LL. Antiinfectives in breastmilk. Part II: Sulfonamides, tetracyclines, macrolides, aminoglycosides and antimalarials. J Hum Lact. 1992Abstract
  18. 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
  19. Sytnik SI. [Antibiotic sensitivity of Staphylococci populating the breast skin of nursing women]. Antibiot Khimioter. 1989Abstract
  20. Stang H. Pyloric stenosis associated with erythromycin ingested through breastmilk. Minn Med. 1986Abstract
  21. Matsuda S. Transfer of antibiotics into maternal milk. Biol Res Pregnancy Perinatol. 1984Abstract
  22. Knowles JA. Effects on the infant of drug therapy in nursing mothers. Drug Ther (NY). 1973Abstract