Is Erythromycin safe while breastfeeding?

Effects on the breastfed infant

Pyloric stenosis, vomiting, sedation, poor sucking and poor weight gain probably related to erythromycin in breastmilk was reported in a 3-week-old infant.[ 4 ] A cohort study of infants diagnosed with infantile hypertrophic pyloric stenosis found that affected infants were 2.3 to 3 times more likely to have a mother taking a macrolide antibiotic during the 90 days after delivery. Stratification of the infants found the odds ratio to be 10 for female infants and 2 for male infants. All of the mothers of affected infants nursed their infants. Seventy-two percent of the macrolide prescriptions were for erythromycin. However, the authors did not state which macrolide was taken by the mothers of the affected infants.[ 5 ] A study comparing the breastfed infants of mothers taking amoxicillin to those taking a macrolide antibiotic found no instances of pyloric stenosis. However, most of the infants exposed to a macrolide in breastmilk were exposed to roxithromycin. Only 2 of the 55 infants exposed to a macrolide were exposed to erythromycin. Adverse reactions occurred in 12.7% of the infants exposed to macrolides which was similar to the rate in amoxicillin-exposed infants. Reactions included rash, diarrhea, loss of appetite, and somnolence.[ 6 ] A retrospective database study in Denmark of 15 years of data found a 3.5-fold increased risk of infantile hypertrophic pyloric stenosis in the infants of mothers who took a macrolide during the first 13 days postpartum, but not with later exposure. The proportion of infants who were breastfed was not known, but probably high. The proportion of women who took each macrolide was also not reported.[ 7 ] In one telephone follow-up study, mothers reported diarrhea 2 infants and irritability in 2 infants out of 17 infants whose mothers were taking erythromycin during breastfeeding. None of the reactions required medical attention.[ 8 ] Two meta-analyses failed to demonstrate a relationship between maternal macrolide use during breastf

Effects on milk supply

Relevant published information was not found as of the revision date.

Levels in milk

Maternal Levels. Two women were given a single dose of 500 mg erythromycin (salt unspecified) orally, and milk levels were measured at 2 and 6 hours after the dose. Average erythromycin milk levels at 2, 4, and 6 hours after the dose were 1, 1.2 and 1.1 mg/L, respectively.[ 2 ] Fifteen women who were 1 month postpartum were given a single 500 mg dose of erythromycin intravenously. Mean breastmilk levels 2 hours after the dose were 2.5 mg/L.[ 3 ] Infant Levels. Relevant published information was not found as of the revision date.

Alternatives LactMed lists

• Benzoyl Peroxide
• Clindamycin
• Tretinoin