Pregnancy is always a special situation where every action or side effect of the drug varies when compared to a situation of a non-pregnant patient. It is not only because the pregnant woman's metabolism differs due to the hormonal and other changes happened to her, but also because every medicine or its metabolite passes to the baby and shows its action there. The only thing is, be cautious, attentive and well supervised when you take any single drug in pregnancy. The interactions can vary in pregnancy, and the dosage may differ as well. Strict supervision of the Physician is mandatory.
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Erythromycin crosses the placenta in small amounts. In one study of 11 patients who had detectable Erythromycin levels in the serum, 4 infants did not have detectable cord concentrations. The cord concentrations in the remaining 7 infants generally ranged from 1% to 6% of that found in maternal serum. A case of left absence-of-tibia syndrome was reported in an infant whose mother had received Erythromycin, ethisterone, and ethinyl estradiol at approximately 4 weeks gestation. Erythromycin has been used prior to delivery in women colonized with group B beta-hemolytic streptococcus to reduce infant colonization. No adverse events in the infants have been reported. Erythromycin has also been used to treat genital Mycoplasma infection during the first trimester without evidence of fetal adverse effects. Pregnant women receiving Erythromycin estolate may be more prone to hepatotoxicity. In one study of women receiving Erythromycin estolate between the 22nd and 32nd week of pregnancy, 10% showed abnormal levels of SGOT.
Erythromycin has been assigned to pregnancy category B by the FDA. Animal studies failed to reveal evidence of teratogenicity. There are no controlled data in human pregnancy. The Centers for Disease Control and Prevention considers Erythromycin the drug of choice for treatment of Chlamydia infections in pregnant women. However, Erythromycin estolate is considered contraindicated because of drug-related hepatotoxicity. Erythromycin should only be given during pregnancy when need has been clearly established.
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Erythromycin breastfeeding
When a drug is taken when the patient is breast feeding, a part of the drug is secreted in her breast milk and is passed to the baby. The dosage of the medicine to mother and baby are different, and many drugs actions are side effects when you take them without a disease, and what if you the baby takes them without a disease? What if the drug is contraindicated in newborns, infants or children? So, breastfeeding is a very alarming situation when the mother is on medications. Ask your Physician or Pediatrician about the effect of the drug on the baby and how much is excreted in breast milk and if it harms the baby!
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Erythromycin is excreted into human milk in small amounts. Erythromycin is considered compatible with breast-feeding by the American Academy of Pediatrics.
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References for pregnancy information
Mahon BE, Rosenman MB, Kleiman MB "Maternal and infant use of Erythromycin and other macrolide antibiotics as risk factors for infantile hypertrophic pyloric stenosis." J Pediatr 139 (2001): 380-4
U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control "1993 Sexually Transmitted Diseases Treatment Guidelines." MMWR Morb Mortal Wkly Rep 42 (1993): 27-46
Philipson A, Sabath LD, Charles D "Transplacental passage of Erythromycin and clindamycin." N Engl J Med 288 (1973): 1219-21
Merenstein GB, Todd WA, Brown G, Yost CC, Luzier T "Group B beta-hemolytic streptococcus: randomized controlled treatment study at term." Obstet Gynecol 55 (1980): 315-8
Easmon CS, Hastings MJ, Deeley J, Bloxham B, Rivers RP, Marwood R "The effect of intrapartum chemoprophylaxis on the vertical transmission of group B streptococci." Br J Obstet Gynaecol 90 (1983): 633-5
Louik C, Werler MM, Mitchell AA "Erythromycin use during pregnancy in relation to pyloric stenosis." Am J Obstet Gynecol 186 (2002): 288-90
Hussain N, Herson VC "Erythromycin use during pregnancy in relation to pyloric stenosis." Am J Obstet Gynecol 187(3 Pt 1) (2002): 821-2
McCormack WM, George H, Donner A, et al. "Hepatotoxicity of Erythromycin estolate during pregnancy." Antimicrob Agents Chemother 12 (1977): 630-5
Quinn PA, Shewchuk AB, Shuber J, et al. "Eficacy of antibiotic therapy in preventing spontaneous pregnancy loss among couples colonized with genital mycoplasms." Am J Obstet Gynecol 145 (1983): 239-44
Jaffe P, Liberman MM, McFadyen I, Valman HB "Incidence of congenital limb-reduction deformities." Lancet 1 (1975): 526-7
Kiefer L, Rubin A, McCoy JB, Foltz EL "The placental transfer of Erythromycin." Am J Obstet Gynecol 69 (1955): 174-7
Roberts RJ, Blumer JL, Gorman RL, et al "American Academy of Pediatrics Committee on Drugs: Transfer of drugs and other chemicals into human milk." Pediatrics 84 (1989): 924-36
Committee on Drugs, 1992 to 1993 "The transfer of drugs and other chemicals into human milk." Pediatrics 93 (1994): 137-50
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References
DailyMed. "ERYTHROMYCIN: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
PubMed Health. "Theramycin Z: This section provide the link out information of drugs collectetd in PubMed Health. ". http://www.ncbi.nlm.nih.gov/pubmedhe... (accessed September 17, 2018).
Human Metabolome Database (HMDB). "Erythromycin: The Human Metabolome Database (HMDB) is a freely available electronic database containing detailed information about small molecule metabolites found in the human body.". http://www.hmdb.ca/metabolites/HMDB0... (accessed September 17, 2018).
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