Question

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

Erythromycin lactation summary

Erythromycin usage has low risk in breastfeeding
  • DrLact safety Score for Erythromycin is 3 out of 8 which is considered Low Risk as per our analyses.
  • A safety Score of 3 indicates that usage of Erythromycin may cause some minor side effects in breastfed baby.
  • Our study of different scientific research indicates that Erythromycin may cause moderate to no side effects in lactating mother.
  • Most of scientific studies and research papers declaring usage of Erythromycin low risk in breastfeeding are based on normal dosage and may not hold true for higher dosage.
  • While using Erythromycin We suggest monitoring child for possible reactions. It is also important to understand that side effects vary largely based on age of breastfed child and time of medication in addition to dosage.
  • Score calculated using the DrLact safety Version 1.2 model, this score ranges from 0 to 8 and measures overall safety of drug in lactation. Scores are primarily calculated using publicly available case studies, research papers, other scientific journals and publically available data.

Answer by Dr. Ru: About Erythromycin usage in lactation

Excreted in very low levels into breast milk. Commonly used for pediatric treatment of small babies; it is very well tolerated by infants. Erythromycin is a macrolide that has been related to hypertrophic pyloric stenosis after early exposition through the breast milk. Avoiding its use in the first post-partum month would be a cautious measure. Be aware of the possibility of false negative results of bacterial cultures when the mother is on antibiotics. Also, diarrheal disease due to imbalance of intestinal flora is possible 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. Systemic treatments would be safer after the first month of life. The American Academy of Pediatrics rates it usually compatible with breastfeeding. List of Essential Medicines WHO 2002: Compatible with breastfeeding.

Answer by DrLact: About Erythromycin usage in lactation

Because of the low levels of erythromycin in breastmilk and safe administration directly to infants, it is acceptable in nursing mothers. The small amounts in milk are unlikely to cause adverse effects in the infant. Monitor the infant for irritability and possible effects on the gastrointestinal flora, such as diarrhea, candidiasis (thrush, diaper rash). One case report and unconfirmed epidemiologic evidence indicates that the risk of hypertrophic pyloric stenosis in infants might occur during maternal use of erythromycin during breastfeeding; however, if it occurs, the frequency is very low. Infant side effects are unlikely with topical application for acne, although topical application to the nipple may increase the risk of diarrhea in the infant. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.[1]

Erythromycin Side Effects in Breastfeeding

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]

Alternate Drugs

Amikacin(Safe)
Clindamycin(Low Risk)
Zidovudine(Low Risk)
Econazole(Safe)
Levofloxacin(Low Risk)
Kanamycin(Safe)
Nafcillin(Safe)
Tenofovir(Safe)
Cefixime(Safe)
Valganciclovir(Low Risk)
Demeclocycline(Low Risk)
Primaquine(Low Risk)
Ganciclovir(Low Risk)
Moxifloxacin(Low Risk)
Malathion(Low Risk)
Atovaquone(Low Risk)
Efavirenz(Unsafe)
Acyclovir(Safe)
Saquinavir(Unsafe)
Cefepime(Safe)
Linezolid(Low Risk)
Didanosine(Unsafe)
Quinine(Safe)
Cefprozil(Safe)
Aztreonam(Safe)
Methicillin(Low Risk)
Ritonavir(Unsafe)
Gatifloxacin(Low Risk)
Ofloxacin(Safe)
Cefdinir(Safe)
Abacavir(Safe)
Nevirapine(Low Risk)
Famciclovir(Low Risk)
Cefoxitin(Safe)
Meropenem(Safe)
Nelfinavir(Unsafe)
Cefazolin(Safe)
Dapsone(Low Risk)
Rifaximin(Safe)
Enoxacin(Low Risk)
Capreomycin(Low Risk)
Cefotetan(Safe)
Amantadine(Low Risk)
Lindane(Unsafe)
Erythromycin(Low Risk)
Doxycycline(Low Risk)
Ertapenem(Safe)
Lomefloxacin(Low Risk)
Indinavir(Unsafe)
Neomycin(Safe)
Cefaclor(Safe)
Naftifine(Safe)
Levofloxacin(Low Risk)
Nalidixic Acid(Low Risk)
Mupirocin(Safe)
Amikacin(Safe)
Nafcillin(Safe)
Cefixime(Safe)
Kanamycin(Safe)
Demeclocycline(Low Risk)
Moxifloxacin(Low Risk)
Cefepime(Safe)
Cefprozil(Safe)
Aztreonam(Safe)
Methicillin(Low Risk)
Gatifloxacin(Low Risk)
Ofloxacin(Safe)
Cefdinir(Safe)
Methenamine(Unsafe)
Cefoxitin(Safe)
Cefazolin(Safe)
Enoxacin(Low Risk)
Capreomycin(Low Risk)
Cefotetan(Safe)
Erythromycin(Low Risk)
Doxycycline(Low Risk)
Ertapenem(Safe)
Iodine(Unsafe)
Lomefloxacin(Low Risk)
Neomycin(Safe)
Cefaclor(Safe)
Clindamycin(Low Risk)
Hydroquinone(Low Risk)
Secukinumab(Low Risk)
Tazarotene(Low Risk)
Adapalene(Safe)
Isotretinoin(Unsafe)
Ustekinumab(Low Risk)
Erythromycin(Low Risk)
Pimecrolimus(Low Risk)
Neomycin(Safe)
Erythromycin(Low Risk)
Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. We do not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.