Azithromycin is a widely used antibiotic prescribed to treat various bacterial infections, including respiratory, skin, and ear infections. Breastfeeding mothers often express concern about the safety of medications they take, wondering if these drugs could transfer to their infants through breast milk. Understanding how azithromycin behaves in the body and its potential presence in breast milk can help alleviate these concerns.
Azithromycin Presence in Breast Milk
Medications transfer from a mother’s bloodstream into breast milk through various mechanisms, primarily passive diffusion. This process is influenced by the drug’s properties, such as its molecular weight, lipid solubility, and protein binding. Azithromycin concentrates in bodily tissues rather than remaining in high bloodstream levels, limiting its transfer into breast milk. Studies generally indicate that azithromycin passes into breast milk at low levels. Infants typically receive less than 1% of a weight-adjusted pediatric dose through breast milk. While one study found a median estimated cumulative infant dose that exceeded a suggested safety limit, this was in a specific context of a single large dose given during labor, and overall, levels are considered low.
Potential Impact on Breastfed Infants
Given the low levels of azithromycin found in breast milk, significant adverse effects on breastfed infants are not commonly expected. Azithromycin is, in fact, sometimes prescribed directly to infants for various infections, often at doses higher than what they would receive through breast milk. Despite the low risk, mild and uncommon side effects have been reported in breastfed infants, primarily involving gastrointestinal upset. These include diarrhea, vomiting, or candidiasis (thrush or diaper rash). There has been discussion regarding a potential, very low risk of infantile hypertrophic pyloric stenosis with maternal macrolide antibiotic use, including azithromycin, particularly in the first two weeks of breastfeeding. However, this association is often questioned or considered unconfirmed by many experts.
Guidance for Breastfeeding Mothers
Breastfeeding mothers considering or taking azithromycin should always consult a healthcare provider. This allows for a thorough discussion of the mother’s medical needs, treatment benefits, and any potential, rare risks to the infant. Healthcare professionals can weigh these factors to make an informed decision regarding the medication. Mothers can usually continue to breastfeed normally without needing to pump and discard milk or adjust feeding schedules. Monitor the infant for any changes in behavior or health, such as altered feeding patterns, sleep, or gastrointestinal symptoms like unusual stool consistency. While such reactions are uncommon, reporting any concerns to the infant’s pediatrician or the prescribing doctor is prudent.