Clindamycin Safety During Breastfeeding
Clindamycin is generally safe to use during breastfeeding, but mothers should monitor their infants for possible gastrointestinal side effects such as diarrhea, candidiasis, or blood in stool. 1, 2
Safety Profile
Clindamycin appears in human breast milk in low concentrations, ranging from less than 0.5 to 3.8 mcg/mL according to the FDA drug label 1. This limited transfer into breast milk means that the risk to the breastfed infant is minimal in most cases.
The FDA states that if clindamycin is required by a nursing mother, it is not a reason to discontinue breastfeeding, though monitoring the infant for potential adverse effects is recommended 1.
Potential Side Effects to Monitor
When using clindamycin while breastfeeding, mothers should watch for:
- Diarrhea in the infant
- Oral candidiasis (thrush)
- Diaper rash
- Blood in stool (rare, but could indicate antibiotic-associated colitis)
- Unusual fussiness or lethargy 2, 1
Recommendations for Use
The North American Clinical Practice Guidelines for the management of hidradenitis suppurativa specifically mentions that clindamycin is safe during breastfeeding but notes the potential for gastrointestinal effects in infants 3.
When prescribing clindamycin to breastfeeding mothers:
- Use the lowest effective dose
- Consider timing administration just after breastfeeding to minimize concentration in milk during the next feeding
- Choose shorter courses of therapy when possible
- Monitor the infant for signs of gastrointestinal disturbance 2
Alternative Antibiotics
If there are concerns about using clindamycin, several alternative antibiotics have established safety profiles during breastfeeding:
- Penicillins and amoxicillin-clavulanate are considered first-line choices and very safe during breastfeeding 2
- Cephalosporins are generally safe with minimal passage into breast milk 2
- Macrolides (except during the first 13 days postpartum due to a very low risk of infantile hypertrophic pyloric stenosis) 3, 2
Clinical Perspective
Most antibiotics, including clindamycin, are considered compatible with breastfeeding 4, 5. The benefits of treating the mother's infection typically outweigh the minimal risks to the breastfed infant.
The American Academy of Dermatology guidelines indicate that clindamycin should be used with caution due to the potential for GI side effects in the infant, but it does not contraindicate its use during breastfeeding 2.
Conclusion
Clindamycin can be safely used during breastfeeding with appropriate monitoring of the infant. The mother should continue breastfeeding while taking the medication, as temporary interruption of breastfeeding is generally not necessary and could be detrimental to the nursing relationship 1, 5.