克林霉素

A lincosamide-derived antibiotic active against many Gram-positive bacteria (staphylococci, streptococci, Clostridium), as well as some anaerobes (Bacteroides fragilis) and parasites (Plasmodium, Toxoplasma). Administered orally, intramuscularly or intravenously in 3 to 4 daily doses. Topical application to the skin and vaginally.

It is excreted in breast milk in small, clinically insignificant amounts ^{(van Wattum 2019, Zhang 1997, Matsuda 1984, Stéen 1982, Smith 1975)} and no problems have been observed in infants whose mothers were taking it, apart from occasional gastroenterocolitis due to an alteration in the gut microbiota, which resolves within a few days of finishing treatment. ^{(Mann 1980)}
Clindamycin may be administered intravenously for the treatment of severe acute mastitis, with no side effects in the infant ^{(Maier 2021)}, although it is a second-line treatment. ^{(Mitchel 2022)}

Bear in mind the possibility of transient gastroenteritis due to changes in the gut microbiota in infants whose mothers are taking antibiotics. ^{(Ito 1993)}

DERMATOLOGICAL AND VAGINAL USE:
The low dose and poor plasma absorption of most topical dermatological preparations make it unlikely that significant amounts will pass into breast milk. Less than 5% of topical clindamycin ^{(Yagui 2024, Ly 2023, van Hoogdalem 1998, Eller 1998, Barza 1982)}, 10% of the vaginal cream and 30% of the vaginal ovule ^{(Borin 1999, 1995 and 1990)} pass into plasma.
Do not apply to the breast to prevent the infant from ingesting it; if necessary, apply after a feed and clean thoroughly with water before the next one. It is advisable to avoid applying creams, gels and other topical products containing paraffin (mineral oil) to the nipple so that the infant does not absorb them. ^{(Concin 2008, Noti 2003)}

Clindamycin is an antibiotic authorised for use in paediatrics, including in preterm infants.
Expert authors consider the use of this medication during breastfeeding to be safe. ^{(Mitchel 2022, Hale, van Wattum 2019, Saito 2018, Briggs 2015, Schaefer 2015, Butler 2014, Amir 2014 and 2011, Kong 2013, Mitrano 2009, Spencer 2008, Nahum 2006, Chin 2001)}  American Academy of Paediatrics: medication usually compatible with breastfeeding. ^{(AAP 2001)}