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The safety of macrolides during lactation
L H Goldstein1, M Berlin, L Tsur
1Clinical Pharmacology Service, Haemek Medical Center, Afula, Bruce Rappaport School of Medicine, Technion, Haifa, Israel. Goldstein_le@clalit.org.il
Summary
Macrolide antibiotics are generally safe for breastfed infants, with comparable adverse reactions to amoxicillin. This study found no association between macrolide exposure via breastmilk and pyloric stenosis in infants.
Area of Science:
- Pediatrics
- Pharmacology
- Neonatal Care
Background:
- Infantile macrolide exposure linked to hypertrophic pyloric stenosis.
- Potential macrolide-motilin receptor interaction implicated.
- Concerns exist regarding macrolide transfer via breastmilk.
Purpose of the Study:
- Assess the safety of macrolide antibiotics during lactation.
- Evaluate the risk of adverse reactions in breastfed infants.
- Investigate the association between maternal macrolide use and infant pyloric stenosis.
Main Methods:
- Prospective, controlled observational study.
- Compared infants exposed to macrolides (erythromycin, azithromycin, clarithromycin, roxithromycin) with those exposed to amoxicillin via breastmilk.
- Monitored infants for adverse reactions.
Main Results:
- Comparable rates of minor adverse reactions (12.7% macrolides vs. 8.3% amoxicillin).
- Adverse reactions included rash, diarrhea, loss of appetite, and somnolence.
- No statistically significant association found between macrolide type and adverse reactions.
Conclusions:
- Macrolide and amoxicillin exposure during breastfeeding showed similar rates of minor infant adverse reactions.
- Macrolide exposure via breastmilk was not associated with pyloric stenosis in this cohort.
- Larger prospective studies are needed to confirm these findings.
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