From the Guidelines
Azithromycin is generally considered safe to use during breastfeeding, with minimal risk to the nursing infant, as supported by recent guidelines 1.
Key Points to Consider
- The amount of azithromycin that passes into breast milk is small, resulting in minimal exposure to the infant 1.
- The typical adult dose of azithromycin would deliver less than 1% of the weight-adjusted pediatric dose to the infant through breast milk.
- No adverse effects have been consistently reported in breastfed infants whose mothers were taking azithromycin, although there is a very low risk of hypertrophic pyloric stenosis in infants exposed to macrolides during the first 13 days of breastfeeding 1.
- Azithromycin is commonly prescribed to infants directly for certain infections, further supporting its safety profile.
- As with any medication during lactation, it's advisable to monitor the infant for potential side effects such as diarrhea, vomiting, or skin rash, though these are rare.
Recommendations
- Mothers can continue to breastfeed normally without needing to pump and discard milk or adjust feeding schedules while taking azithromycin.
- The benefits of treating the mother's infection with azithromycin typically outweigh any theoretical risks to the breastfed infant, as suggested by recent clinical practice guidelines 1.
- Azithromycin is a suggested option for breastfeeding patients who require systemic antibiotics, according to the latest clinical guidelines 1.
From the FDA Drug Label
Nursing Mothers It is not known whether azithromycin is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when azithromycin is administered to a nursing woman.
The use of azithromycin during breastfeeding is not recommended due to the lack of information on its excretion in human milk. Caution should be exercised when administering azithromycin to a nursing woman 2.
From the Research
Azithromycin Safety During Breastfeeding
- Azithromycin is a macrolide antibiotic that has been studied for its safety during breastfeeding, with some studies indicating its presence in breast milk 3.
- A case report published in the American Journal of Obstetrics and Gynecology found that azithromycin appears to demonstrate a time-dependent versus time-accumulation profile in breast milk 3.
- However, a study published in the journal Breastfeeding Medicine found that infant exposure to macrolides, including azithromycin, via breast milk may be associated with pyloric stenosis, although the evidence is not conclusive 4.
- Another study published in Pediatrics found that azithromycin given to women in labor decreases infections in both women and newborns during the puerperal period, but did not specifically address breastfeeding safety 5.
- A review of medicines used during breastfeeding published in the Australian Family Physician journal noted that most medicines, including antibiotics like azithromycin, can be used safely during breastfeeding at the recommended dose, but cautioned that there are exceptions that necessitate caution 6.
- A comprehensive narrative review published in Clinical Drug Investigation found that there is no conclusive evidence to support that azithromycin use by pregnant women causes adverse outcomes in their offspring, but recommended that the drug should only be used during pregnancy when clinically indicated 7.
- A prospective, controlled observational study published in Breastfeeding Medicine found that the rate of adverse reactions in infants exposed to macrolides, including azithromycin, via breast milk was comparable to those exposed to amoxicillin 4.