Last update Nov. 4, 2018

C23 H45 N5 O14


Safe substance and/or breastfeeding is the best option.

An antibacterial aminoglycoside used orally in the treatment of intestinal infestations by protozoa (giardia, amoeba and cryptosporidiosis) and by tapeworms. It is also administered orally to suppress intestinal flora prior to surgical interventions and encephalopathy and hepatic coma.
It is used topically in cutaneous leishmaniasis (Garnier 2002) and intramuscularly in visceral leishmaniasis (Musa 2010).

Since the last update we have not found published data on its excretion in breastmilk.

Its practically zero oral bioavailability (Kip 2018, Bissuel 1994) and cutaneous bioavailability (Ravis 2013) impede transfer to the mother’s plasma and therefore it is unlikely that it will be excreted in breastmilk in amounts that could be significant.
Still injected intramuscularly, its lack of lipid solubility (Kit 2018) and short half-life would greatly hinder excretion in breastmilk.

This same low oral bioavailability hinders transfer to infant plasma from breastmilk, except in premature babies and the immediate neonatal period when there may be increased intestinal permeability.

The possible negativity of cultures in febrile infants whose mothers take antibiotics should be taken into account, as well as the possibility of gastroenteritis due to alteration of the intestinal flora (Ito 1993).


We do not have alternatives for C23 H45 N5 O14 since it is relatively safe.

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

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.


Variable Value Unit
Oral Bioavail. < 1 %
Molecular weight 616 daltons
Protein Binding 33 %
VD 0.22 l/Kg
pKa 9.94 -
2.62 hours


  1. Kip AE, Schellens JHM, Beijnen JH, Dorlo TPC. Clinical Pharmacokinetics of Systemically Administered Antileishmanial Drugs. Clin Pharmacokinet. 2018 Abstract Full text (link to original source) Full text (in our servers)
  2. Ravis WR, Llanos-Cuentas A, Sosa N, Kreishman-Deitrick M, Kopydlowski KM, Nielsen C, Smith KS, Smith PL, Ransom JH, Lin YJ, Grogl M. Pharmacokinetics and absorption of paromomycin and gentamicin from topical creams used to treat cutaneous leishmaniasis. Antimicrob Agents Chemother. 2013 Abstract
  3. Musa AM, Younis B, Fadlalla A, Royce C, Balasegaram M, Wasunna M, Hailu A, Edwards T, Omollo R, Mudawi M, Kokwaro G, El-Hassan A, Khalil E. Paromomycin for the treatment of visceral leishmaniasis in Sudan: a randomized, open-label, dose-finding study. PLoS Negl Trop Dis. 2010 Abstract
  4. Arbex MA, Varella Mde C, Siqueira HR, Mello FA. Antituberculosis drugs: drug interactions, adverse effects, and use in special situations. Part 2: second line drugs. J Bras Pneumol. 2010 Abstract Full text (link to original source) Full text (in our servers)
  5. Garnier T, Croft SL. Topical treatment for cutaneous leishmaniasis. Curr Opin Investig Drugs. 2002 Abstract
  6. Bissuel F, Cotte L, de Montclos M, Rabodonirina M, Trepo C. Absence of systemic absorption of oral paromomycin during long-term, high-dose treatment for cryptosporidiosis in AIDS. J Infect Dis. 1994 Abstract
  7. 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

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