Is Azithromycin Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Azithromycin? Is Azithromycin safe for nursing mother and child? Does Azithromycin extracts into breast milk? Does Azithromycin has any long term or short term side effects on infants? Can Azithromycin influence milk supply or can Azithromycin decrease milk supply in lactating mothers?

Excreted in very low levels into breast milk and commonly used for pediatric treatment. Early exposition to Macrolides (mostly Erythromycin) have been related to hypertrophic pyloric stenosis. Avoiding use in the first post-partum month would be advisable yet it may occurred while breastfeeding. Be aware of false negative bacterial cultures in the infant when the mother is on antibiotics. Also, diarrheal disease due to imbalance of intestinal flora is possible.

Because of the low levels of azithromycin in breastmilk and use in infants in higher doses, it would not be expected to cause adverse effects in breastfed infants. Monitor the infant for possible effects on the gastrointestinal flora, such as diarrhea, candidiasis (thrush, diaper rash). Unconfirmed epidemiologic evidence indicates that the risk of hypertrophic pyloric stenosis in infants might be increased by maternal use of macrolide antibiotics during breastfeeding. A single dose of azithromycin given during labor to women who were nasal carriers of pathogenic and reduced the counts of these bacteria in breastmilk in one study.

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. Most of the macrolide prescriptions were for erythromycin, but only 7% were for azithromycin. However, the authors did not state which macrolide was taken by the mothers of the affected infants.[4] 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.[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 10 of the 55 infants exposed to a macrolide were exposed to azithromycin. 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] Eight women who were given azithromycin 500 mg intravenously 15, 30 or 60 minutes prior to incision for cesarean section breastfed their newborn infants. No adverse events were noted in their infants.[2]

In a double-blind, controlled study in Gambia, women who were nasopharyngeal carriers of , or group B streptococcus were given a single 2 gram dose of azithromycin during labor. Milk samples from women who received azithromycin had 9.6% prevalence of carriage of the organisms compared to 21.9% in women who received placebo. Nasopharyngeal carriage in mothers and infants was also reduced on day 6 postpartum.[7]