The Basics
What is Erythromycin?
Used to prevent and treat infections in many different parts of the body, including respiratory tract infections, skin infections, diphtheria, intestinal amebiasis, acute pelvic inflammatory disease, Legionnaire’s disease, pertussis, and syphilis. Also used to prevent recurrent attacks of rheumatic fever in patients who have had an allergic reaction to penicillin or sulfa drugs.
Brand names for Erythromycin
Benzamycin
How Erythromycin is classified
Anti-Infective Agents, Antibacterial Agents, Dermatologic Agents, Macrolides
Erythromycin During Pregnancy
Erythromycin pregnancy category
Category CNote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.
What we know about taking Erythromycin while pregnant
There was no evidence of teratogenicity or any other adverse effect on reproduction in female rats fed erythromycin base (up to 0.25% diet) prior to and during mating, during gestation and through weaning of two successive litters. There are no well-controlled trials in pregnant women with BENZAMYCIN (erythromycin) Topical Gel. It also is not known whether BENZAMYCIN (erythromycin) Topical Gel can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity. BENZAMYCIN (erythromycin) Topical Gel should be given to a pregnant woman only if clearly needed.
Taking Erythromycin While Breastfeeding
What are recommendations for lactation if you're taking Erythromycin?
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 hypertrophic pyloric stenosis in infants might occur with maternal use of erythromycin during the first two weeks of breastfeeding; however, if it occurs, the frequency is very low and others have questioned this relationship. 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]
Maternal / infant drug levels
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 hypertrophic pyloric stenosis in infants might occur with maternal use of erythromycin during the first two weeks of breastfeeding; however, if it occurs, the frequency is very low and others have questioned this relationship. 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]
Possible effects of Erythromycin on milk supply
Relevant published information was not found as of the revision date.
Possible alternatives to Erythromycin
(Systemic Infections) Azithromycin, Clarithromycin; (Topical for Acne) Azelaic Acid, Benzoyl Peroxide, Clindamycin, Tretinoin.
List of References
Lactation sources: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/1. Noti A, Grob K, Biedermann M. Exposure of babies to C(15)-C(45) mineral paraffins from human milk and breast salves. Regul Toxicol Pharmacol. 2003;38:317-25. PMID: 14623482
2. Matsuda S. Transfer of antibiotics into maternal milk. Biol Res Pregnancy Perinatol. 1984;5:57-60. PMID: 6743732
3. Zhang Y, Zhang Q, Xu Z. [Tissue and body fluid distribution of antibacterial agents in pregnant and lactating women]. Zhonghua Fu Chan Ke Za Zhi. 1997;32:288-92. PMID: 9596854
4. Stang H. Pyloric stenosis associated with erythromycin ingested through breast milk. Minn Med. 1986;69:669-70, 82. PMID: 3796569
5. Sorensen HT, Skriver MV, Pedersen L et al. Risk of infantile hypertrophic pyloric stenosis after maternal postnatal use of macrolides. Scand J Infect Dis. 2003;35:104-6. PMID: 12693559
6. Ito S, Blajchman A, Stephenson M et al. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993;168:1393-9. PMID: 8498418
7. Goldstein LH, Berlin M, Tsur L et al. The safety of macrolides during lactation. Breastfeed Med. 2009;4:197-200. PMID: 19366316
8. Lund M, Pasternak B, Davidsen RB et al. Use of macrolides in mother and child and risk of infantile hypertrophic pyloric stenosis: Nationwide cohort study. BMJ. 2014;348:g1908. PMID: 24618148
9. Abdellatif M, Ghozy S, Kamel MG et al. Association between exposure to macrolides and the development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis. Eur J Pediatr. 2019;178:301-14. PMID: 30470884
10. Almaramhy HH, Al-Zalabani AH. The association of prenatal and postnatal macrolide exposure with subsequent development of infantile hypertrophic pyloric stenosis: A systematic review and meta-analysis. Ital J Pediatr. 2019;45:20. PMID: 30717812
Disclaimer: This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Consult your healthcare provider with any questions.
