Last update: Jan. 15, 2020

Clarithromycin

Very Low Risk for breastfeeding


Safe. Compatible.
Minimal risk for breastfeeding and infant.

A macrolide with actions and uses very similar to erythromycin.
Indicated in respiratory infections, mycobacterial infections and in gastric and duodenal ulcers associated with Helicobacter pylori.
Administered orally twice daily.

It is excreted in breastmilk in very small amounts (Sedlmayr 1993). 12% of infants whose mothers were taking it had mild side effects such as gastroenteritis or drowsiness (Goldstein 2009).

It is an antibiotic commonly used in pediatrics.

Various medical associations and expert consensus consider it safe to use this medication during breastfeeding (Hale 2019, Briggs 2017, Butler 2014, Schaefer 2007, Goldstein 2009, Mahadevan 2006, Bar-Oz 2003, Chin 2001).

Some authors have linked direct and early exposure (first 15 days of life) to macrolides (especially erythromycin) with hypertrophic pyloric stenosis (Almaramhy 2019, Lund 2014) and also through breastmilk (Maheshwai 2007, Sorensen 2003, Stang 1986) but others have not (Almaramhy 2019, Abdellatif 2019, Goldstein 2009) or not for macrolides which are different to erythromycin (Maheshwai 2007).

The possibility of transient gastroenteritis due to altered intestinal flora in infants whose mothers take antibiotics should be taken into account (Goldstein 2009, Ito 1993).

Alternatives

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

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 50 - 55 %
Molecular weight 748 daltons
Protein Binding 70 - 80 %
VD 2 - 3 l/Kg
pKa 8,99 -
Tmax 1,7 hours
T1/2 3 - 5 hours
M/P ratio 1 -
Theoretical Dose 0,14 mg/Kg/d
Relative Dose 1,7 %
Relat.Ped.Dose 0,9 %

References

  1. Almaramhy HH, Al-Zalabani AH. The association of prenatal and postnatal macrolide exposure with subsequent development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis. Ital J Pediatr. 2019 Feb 4;45(1):20. Abstract
  2. Abdellatif M, Ghozy S, Kamel MG, Elawady SS, Ghorab MME, Attia AW, Le Huyen TT, Duy DTV, Hirayama K, Huy NT. Association between exposure to macrolides and the development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis. Eur J Pediatr. 2019 Mar;178(3):301-314. Abstract
  3. Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: Part II. Lactation. J Am Acad Dermatol. 2014 Mar;70(3):417.e1-10; quiz 427. Abstract
  4. Goldstein LH, Berlin M, Tsur L, Bortnik O, Binyamini L, Berkovitch M. The safety of macrolides during lactation. Breastfeed Med. 2009 Dec;4(4):197-200. Abstract
  5. Maheshwai N. Are young infants treated with erythromycin at risk for developing hypertrophic pyloric stenosis? Arch Dis Child. 2007 Abstract Full text (link to original source) Full text (in our servers)
  6. Mahadevan U, Kane S. American gastroenterological association institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology. 2006 Jul;131(1):283-311. Review. Abstract Full text (link to original source) Full text (in our servers)
  7. 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. 2003 Abstract
  8. 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. 2003;35(2):104-6. Abstract
  9. 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. 2001 Feb;17(1):54-65. Abstract
  10. Sedlmayr T, Peters F, Raasch W, Kees F. [Clarithromycin, a new macrolide antibiotic. Effectiveness in puerperal infections and pharmacokinetics in breast milk]. Geburtshilfe Frauenheilkd. 1993 Jul;53(7):488-91. German. Abstract
  11. 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. 1993 May;168(5):1393-9. Abstract
  12. 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. 1989 Abstract

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