Last update Aug. 31, 2022

Erythromycin

Low Risk

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

Macrolide antibacterial. Oral administration every 6 to 12 hours.

It is excreted in breast milk in negligible amount. (Zhang 1997, Matsuda 1984)

Commonly used for pediatric treatment of small babies; it is very well tolerated by infants. (Ng 2009)

Early direct exposure to erythromycin during the first month has been related to the appearance of hypertrophic pyloric stenosis (Almaramhy 2019, Lund 2014, Maheshwai 2007, Prescrire 2001), but whether it is also through breast milk is controversial, with some authors finding it (Sorensen 2003, Stang 1986) and not others (Abdellatif 2019, Almaramhy 2019, Goldstein 2009, Ito 1991)Avoiding its use in the first post-partum month would be a cautious measureBeyond the first month, erythromycin is compatible with breastfeeding.

Although rare, the possibility of transient gastroenteritis due to alteration of the intestinal flora in infants whose mothers take antibiotics should be taken into account. (Ito 1993)

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. 

Expert authors consider the use of this medication to be compatible during breastfeeding (Hale, LactMed, Briggs 2015, Butler 2014, Kong 2013, ASGE 2012, Bar-Oz 2003, Chin 2001, Fulton 1992)American Academy of Pediatrics: medication usually compatible with breastfeeding. (AAP 2001). Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs: compatible with Breastfeeding. (WHO 2002)

TOPICAL USE:

Topical erythromycin has no risk during lactation.

The small dose and poor plasma absorption of most topical dermatological (van Hoogdalem 1998) or ophthalmological preparations make it unlikely that a significant amount will pass into breast milk.

Do not apply on the breasts to prevent the infant from ingesting it; if necessary, apply after one feeding and clean well with water before the next.

Creams, gels or similar products that contain paraffin (mineral oil) should not be used on the nipple to avoid absorption by the infant. (Concin 2008, Noti 2003)

Alternatives

  • Azelaic Acid ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Azithromycin ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Benzoyl Peroxide ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Clarithromycin ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Clindamycin ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Tretinoin (topical use) ( Safe. Compatible. Minimal risk for breastfeeding and infant.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

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.

Other names

Erythromycin is also known as


Erythromycin in other languages or writings:

Tradenames

Main tradenames from several countries containing Erythromycin in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 18 - 45 %
Molecular weight 734 daltons
Protein Binding 93 %
pKa 13.62 -
Tmax 1.2 hours
1.5 - 2.5 hours
M/P ratio 0.5 - 0.9 -
Theoretical Dose 0.18 - 0.48 mg/Kg/d
Relative Dose 1.5 %
Ped.Relat.Dose 1.3 - 2. 5 %

References

  1. Hale TW. Medications & Mothers' Milk. 1991- . Springer Publishing Company. Available from https://www.halesmeds.com Consulted on March 17, 2022 Full text (link to original source)
  2. LactMed. Drugs and Lactation Database (LactMed). Internet. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/ 2006 - Consulted on March 15, 2022 Full text (link to original source)
  3. 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
  4. van Wattum JJ, Leferink TM, Wilffert B, Ter Horst PGJ. Antibiotics and lactation: An overview of relative infant doses and a systematic assessment of clinical studies. Basic Clin Pharmacol Toxicol. 2019 Jan;124(1):5-17. Abstract
  5. 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
  6. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. Tenth edition (acces on line) 2015
  7. 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. 2014 Mar 11;348:g1908. Abstract Full text (link to original source) Full text (in our servers)
  8. 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
  9. Kong YL, Tey HL. Treatment of acne vulgaris during pregnancy and lactation. Drugs. 2013 Jun;73(8):779-87. Abstract
  10. 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. 2012 Jul;76(1):18-24. Abstract Full text (link to original source) Full text (in our servers)
  11. Fluhr JW, Degitz K. [Antibiotics, azelaic acid and benzoyl peroxide in topical acne therapy]. J Dtsch Dermatol Ges. 2010 Abstract
  12. Ng PC. Use of oral erythromycin for the treatment of gastrointestinal dysmotility in preterm infants. Neonatology. 2009 Abstract Full text (in our servers)
  13. 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
  14. Concin N, Hofstetter G, Plattner B, Tomovski C, Fiselier K, Gerritzen K, Fessler S, Windbichler G, Zeimet A, Ulmer H, Siegl H, Rieger K, Concin H, Grob K. Mineral oil paraffins in human body fat and milk. Food Chem Toxicol. 2008 Abstract
  15. 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)
  16. Worret WI, Fluhr JW. [Acne therapy with topical benzoyl peroxide, antibiotics and azelaic acid]. J Dtsch Dermatol Ges. 2006 Abstract
  17. 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. 2003 Abstract
  18. 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
  19. 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
  20. 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)
  21. [No authors listed] Erythromycin-induced pyloric stenosis in infants. Prescrire Int. 2001 Abstract
  22. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Abstract Full text (link to original source) Full text (in our servers)
  23. 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
  24. van Hoogdalem EJ. Transdermal absorption of topical anti-acne agents in man; review of clinical pharmacokinetic data. J Eur Acad Dermatol Venereol. 1998 Abstract
  25. 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. 1997 Abstract
  26. 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
  27. Fulton B, Moore LL. Antiinfectives in breastmilk. Part II: Sulfonamides, tetracyclines, macrolides, aminoglycosides and antimalarials. J Hum Lact. 1992 Dec;8(4):221-3. Review. No abstract available. Abstract
  28. Sytnik SI. [Antibiotic sensitivity of Staphylococci populating the breast skin of nursing women]. Antibiot Khimioter. 1989 Abstract
  29. 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
  30. Stang H. Pyloric stenosis associated with erythromycin ingested through breastmilk. Minn Med. 1986 Abstract
  31. Matsuda S. Transfer of antibiotics into maternal milk. Biol Res Pregnancy Perinatol. 1984;5(2):57-60. Abstract
  32. Knowles JA. Effects on the infant of drug therapy in nursing mothers. Drug Ther (NY). 1973 Abstract

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