It takes 68-72 hours for half of the dose of the most commonly used oral
formulation of Zithromax to leave the body. I have a faint recall of
hearing 5 half lives back in pharmacy school to get most of something
out of the body, so that would be 15 days after the last dose to ensure
that all of the Zithromax is gone from Mom's body.
That being said, one of my favorite drug references, The Drug
Information Handbook, says "Since serum concentrations determine infant
exposure, azithromycin may achieve treatment results in the mother with
less exposure to the breast-feeding infant." So the unanswered question
is, if we have a Zithromax-allergic baby, when will there be NO
Zithromax in the milk, if it's mostly sequestered in the tissue and kept
out of the blood stream? And is the breast one of those tissues where it
might "loiter?" I don't think we can answer that question right now.
So the answer that I am coming up with is that there is no good certain
answer, which is quite frustrating. If I were this Mom, and I needed
antibiotic treatment again, I would ask for erythromycin next time. It's
got a much shorter half-life (and is much more of a bummer to take) but
it'll be out of her system a lot more quickly.
Laura C. Block, PharmD
------------------------------
Date: Wed, 18 Feb 2009 10:28:59 -0500
From: Margaret and Stewart Wills <[log in to unmask]>
Subject: azithromycin/Zithromax --
Mother of a 10-month old, was on day three of a 5-day Z-Pak of
azithromycin/Zithromax when the baby developed hives (which an older
daughter had also had once in response to antibiotics). The mother and
father are both allergic to penicillin. This mother is understandably
nervous about continuing to breastfeed and the baby possibly having a
more severe allergic reaction. The mother has been told that while she
takes the medication for five days, it remains active in her system for
an additional five. So she has been advised to pump and sacrifice the
milk for five days after ending the course of medication, plus an
additional two days to clear it completely, given its long half-life..
While generally compatible with breastfeeding, with an L2 rating, in the
Medications Forums at Hale's website (not taking questions now) he also
mentions that it does remain active in the system for 10 days. Usually,
since the medication is compatible with breastfeeding, that's not an
issue. But in a special circumstance like this, when the baby has had
an allergic reaction to the small amount transferred, would there be any
way to say that the transfer would continue to be an issue during the
additional five days plus two?
Margaret Wills, LLLL, IBCLC Maryland
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