红霉素

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 measure. Beyond 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)}