Are doxycycline and erythromycin compatible with breast-feeding?/nA 34-year-old lactating woman pla

Fråga: Are doxycycline and erythromycin compatible with breast-feeding? A 34-year-old lactating woman plans to start treatment with doxycycline or erythromycin due to a borrelia infection. The woman is allergic to penicillin and would like to continue breast-feeding her 3-month-old infant.

Sammanfattning: The fraction of doxycycline or erythromycin that might be ingested by the breast-fed infant is regarded to be small. Pyloric stenosis has been associated with erythromycin in some infants, but a causal relationship of these cases could not be established. Basically both erythromycin and doxycycline are regarded compatible with breast-feeding.

Svar: Questions concerning the use of doxycycline and erythromycin during breast-feeding have previously been answered in Drugline (1,2). The conclusion from these documents is that only a small fraction of these drugs reaches breast milk and that both doxycycline and erythromycin are regarded compatible with breastfeeding.

In an updated literature search we found one article describing an infant who developed pyloric stenosis after exposure to erythromycin through breast-feeding (3). The case concerned a female infant who was born normal. At 3 weeks, her mother was treated with erythromycin base (250 mg orally three times daily) for mastitis. Five days into the course, the infant became more irritable and developed persistent non-projectile vomiting. An upper gastrointestinal investigation demonstrated hypertrophic pyloric stenosis and the infant underwent successful pyloromyotomy. After this case, the authors conducted a retrospective chart review of all cases of hypertrophic stenosis at St Paul Children´s Hospital, Minnesota, USA between January 1979 and December 1983. One-hundred and twenty two infants were retrieved (mean age: 38 days). Both the mothers and the infants had received different kinds of drugs during pregnancy or lactation. Only one woman and 6 infants were given erythromycin. The authors do not rule out a possible etiological association between erythromycin and pyloric stenosis in the above described case.