Last update: Aug. 28, 2021

Clindamycin

Very Low Risk for breastfeeding


Safe. Compatible.
Minimal risk for breastfeeding and infant.

Lincosamide antibacterial active against many gram-positive bacteria (staphylococci, streptococci, clostridium) and some anaerobes (Bacteroides fragilis) and parasites (plasmodium, toxoplasma).
Oral, intramuscular or intravenous administration in 3 to 4 daily doses. Topical cutaneous and vaginal administration.

It is excreted in breast milk in clinically insignificant amounts (van Wattum 2019, Zhang 1997, Matsuda 1984, Stéen 1982, Smith 1975) and no problems have been recorded in infants whose mothers were taking it, except occasional gastroenterocolitis due to alteration of the intestinal flora which clears a few days after treatment ends.
Clindamycin is used intravenously in the treatment of severe acute mastitis, without side effects in the infant (Maier 2021).

A single case (Mann 1980) of pseudomembranous colitis has been reported in an infant whose mother was taking clindamycin and gentamicin, although the infant was also receiving intravenous antibiotics.

The possibility of transient gastroenteritis due to altered intestinal flora in infants whose mothers take antibiotics should be taken into account (Ito 1993).

DERMATOLOGICAL AND VAGINAL USE:
The small dose and poor plasma absorption of most topical dermatological preparations make it unlikely that a significant amount will pass into breast milk.
Less than 8% of cutaneous clindamycin passes into plasma (van Hoogdalem 1998, Eller 1998, Barza 1982).
Do not apply on the breasts to prevent the infant from ingesting it; if necessary, apply after one feeding and clean well with water before the next.
It is advisable to avoid the application to the nipple of creams, gels and other topical products containing paraffin (mineral oil) so that the infant does not absorb them (Concin 2008, Noti 2003)
Less than 10% of vaginal clindamycin in cream form and less than 30% of clindamycin in ovule form passes into plasma (Borin 1999, 1995 y 1990).

Expert authors consider the use of this medication safe or probably safe during breastfeeding (Hale, van Wattum 2019, Saito 2018, Briggs 2015, Schaefer 2015, Butler 2014, Amir 2014 y 2011, Kong 2013, Mitrano 2009, Spencer 2008, Nahum 2006, Chin 2001).
American Academy of Pediatrics: medication usually compatible with breastfeeding (AAP 2001).

Alternatives

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Tradenames

Main tradenames from several countries containing Clindamycin in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 90 %
Molecular weight 425 daltons
Protein Binding 94 %
VD 2 l/Kg
pKa 12,4 -
Tmax 0,75 - 1 hours
T1/2 2,4 hours
M/P ratio 0,5 -
Theoretical Dose 0,2 - 0,47 mg/Kg/d
Relative Dose 0,6 - 5 %
Ped.Relat.Dose 1 - 5 %

References

  1. Maier JT, Daut J, Schalinski E, Fischer-Medert T, Hellmeyer L. Severe Lactational Mastitis With Complicated Wound Infection Caused by Streptococcus pyogenes. J Hum Lact. 2021 Feb;37(1):200-206. Abstract
  2. van Wattum JJ, Leferink TM, Wilffert B, Ter Horst PGJ. Antibiotics and lactation: An overview of relative infant doses and a systematic assessment of clinical studies. Basic Clin Pharmacol Toxicol. 2019 Jan;124(1):5-17. Abstract
  3. Saito M, Gilder ME, McGready R, Nosten F. Antimalarial drugs for treating and preventing malaria in pregnant and lactating women. Expert Opin Drug Saf. 2018 Nov;17(11):1129-1144. Abstract Full text (link to original source) Full text (in our servers)
  4. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. Tenth edition (acces on line) 2015
  5. Schaefer C, Peters P, Miller RK. Drugs During Pregnancy and Lactation. Treatment options and risk assessment. Elsevier, Third Edition. 2015
  6. Amir LH; Academy of Breastfeeding Medicine Protocol Committee. ABM Clinical Protocol #4: Mastitis, Revised March 2014. Breastfeed Med. 2014;9(5):239-243. Abstract Full text (link to original source) Full text (in our servers)
  7. Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: Part II. Lactation. J Am Acad Dermatol. 2014 Mar;70(3):417.e1-10; quiz 427. Abstract
  8. Amir LH. y el Comité de protocolos de la Academy of Breastfeeding Medicine. Protocolo clínico de la ABM n.o 4: Mastitis, modi cado en marzo de 2014. Breastfeed Med. 2014;9(5):239-243. Abstract Full text (link to original source) Full text (in our servers)
  9. Kong YL, Tey HL. Treatment of acne vulgaris during pregnancy and lactation. Drugs. 2013 Jun;73(8):779-87. Abstract
  10. Amir LH, Pirotta MV, Raval M. Breastfeeding--evidence based guidelines for the use of medicines. Aust Fam Physician. 2011 Sep;40(9):684-90. Review. Abstract Full text (link to original source) Full text (in our servers)
  11. Mitrano JA, Spooner LM, Belliveau P. Excretion of antimicrobials used to treat methicillin-resistant Staphylococcus aureus infections during lactation: safety in breastfeeding infants. Pharmacotherapy. 2009 Sep;29(9):1103-9. Abstract
  12. Spencer JP. Management of mastitis in breastfeeding women. Am Fam Physician. 2008 Abstract Full text (link to original source) Full text (in our servers)
  13. Concin N, Hofstetter G, Plattner B, Tomovski C, Fiselier K, Gerritzen K, Fessler S, Windbichler G, Zeimet A, Ulmer H, Siegl H, Rieger K, Concin H, Grob K. Mineral oil paraffins in human body fat and milk. Food Chem Toxicol. 2008 Abstract
  14. Nahum GG, Uhl K, Kennedy DL. Antibiotic use in pregnancy and lactation: what is and is not known about teratogenic and toxic risks. Obstet Gynecol. 2006 Abstract
  15. Noti A, Grob K, Biedermann M, Deiss U, Brüschweiler BJ. Exposure of babies to C15-C45 mineral paraffins from human milk and breast salves. Regul Toxicol Pharmacol. 2003 Abstract
  16. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Abstract Full text (link to original source) Full text (in our servers)
  17. Chin KG, McPherson CE 3rd, Hoffman M, Kuchta A, Mactal-Haaf C. Use of anti-infective agents during lactation: Part 2--Aminoglycosides, macrolides, quinolones, sulfonamides, trimethoprim, tetracyclines, chloramphenicol, clindamycin, and metronidazole. J Hum Lact. 2001 Feb;17(1):54-65. Abstract
  18. Borin MT, Ryan KK, Hopkins NK. Systemic absorption of clindamycin after intravaginal administration of clindamycin phosphate ovule or cream. J Clin Pharmacol. 1999 Abstract
  19. van Hoogdalem EJ. Transdermal absorption of topical anti-acne agents in man; review of clinical pharmacokinetic data. J Eur Acad Dermatol Venereol. 1998 Abstract
  20. 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 Abstract
  21. Borin MT, Powley GW, Tackwell KR, Batts DH. Absorption of clindamycin after intravaginal application of clindamycin phosphate 2% cream. J Antimicrob Chemother. 1995 Abstract
  22. Ito S, Blajchman A, Stephenson M, Eliopoulos C, Koren G. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993 May;168(5):1393-9. Abstract
  23. Borin MT. Systemic absorption of clindamycin following intravaginal application of clindamycin phosphate 1% cream. J Clin Pharmacol. 1990 Abstract
  24. Eller MG, Smith RB, Phillips JP. Absorption kinetics of topical clindamycin preparations. Biopharm Drug Dispos. 1989 Sep-Oct;10(5):505-12. Abstract
  25. Matsuda S. Transfer of antibiotics into maternal milk. Biol Res Pregnancy Perinatol. 1984;5(2):57-60. Abstract
  26. Stéen B, Rane A. Clindamycin passage into human milk. Br J Clin Pharmacol. 1982 Abstract Full text (link to original source) Full text (in our servers)
  27. Barza M, Goldstein JA, Kane A, Feingold DS, Pochi PE. Systemic absorption of clindamycin hydrochloride after topical application. J Am Acad Dermatol. 1982 Aug;7(2):208-14. Abstract
  28. Mann CF. Clindamycin and breast-feeding. Pediatrics. 1980 Abstract
  29. Smith JA, Morgan JR, Rachlis AR, Papsin FR. Clindamycin in human breast milk. Can Med Assoc J. 1975 Abstract Full text (in our servers)
  30. Hale TW. Hale's Medications & Mothers' Milk. [Internet]. Springer Publishing Company; 1991-. Available from: https://www.halesmeds.com None

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