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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