toxylact: a07AA06 Paromomycin

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A07AA06 comprises oral paromomycin, an aminoglycoside antibiotic used as a non‑absorbed intestinal anti‑infective in enteric infections; oral paromomycin is generally compatible with breastfeeding because maternal systemic exposure and milk transfer are expected to be minimal.atcddd.fhi+4

Drug and ATC classification

Paromomycin is an aminoglycoside antibacterial agent with activity against a range of intestinal pathogens.kegg+1
Within the ATC system it belongs to the subgroup A07AA (intestinal antibiotics) as A07AA06, used for intestinal infections such as enterocolitis.atcddd.fhi+3
It is formulated for oral use in gram‑strength doses (e.g. 3 g oral daily defined dose) targeting luminal organisms rather than systemic infections.atcddd.fhi

Pharmacology and toxicology

Like other aminoglycosides, paromomycin binds to bacterial ribosomal RNA, interfering with protein synthesis and exerting a bactericidal effect against susceptible organisms.kegg+1
When given orally for intestinal indications, paromomycin is poorly absorbed from the gastrointestinal tract, so most of the administered dose remains within the intestinal lumen and is excreted unchanged in the feces.atcddd.fhi+1
Systemic aminoglycosides can cause nephrotoxicity and ototoxicity, but these toxicities are mainly related to parenteral administration and significant serum concentrations, which are not expected with standard oral intestinal therapy in patients with normal gut mucosa.kegg+1

Use in lactation

Intestinally acting, minimally absorbed antibiotics such as oral paromomycin are typical examples of medicines with very low systemic exposure and therefore very low transfer into breast milk.ncbi.nlm.nih+1
Because oral paromomycin is poorly absorbed, maternal plasma levels and milk concentrations are expected to be extremely low, and relevant exposure of the breastfed infant through milk is unlikely.atcddd.fhi+1
On this basis, A07AA06 paromomycin is generally considered compatible with breastfeeding, and lactation can usually continue without interruption while monitoring the infant for nonspecific gastrointestinal effects such as diarrhoea or changes in stool flora.ncbi.nlm.nih+2

Clinical considerations in breastfeeding women

Before prescribing, clinicians should verify that the preparation is an oral intestinal formulation (A07AA06) and not a systemic aminoglycoside, because systemic therapy involves higher risks of maternal nephro‑ and ototoxicity and potentially greater milk transfer.atcddd.fhi+2
Standard lactation‑pharmacology principles apply: use the lowest effective dose for the shortest necessary duration, consider maternal renal function, and avoid simultaneous use of other nephrotoxic medications.ncbi.nlm.nih+1
Consistent with major lactation resources, most maternal medications, including poorly absorbed intestinal antibiotics, are not absolute contraindications to breastfeeding and should be assessed individually in terms of maternal benefit and potential infant risk.ncbi.nlm.nih+1


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