Is topical clindamycin safe during pregnancy?

What does the evidence say about topical clindamycin during pregnancy?

1. Using topical clindamycin is unlikely to increase the chance of miscarriage, birth defects, low birth weight, or preterm delivery, and very little of the drug applied to the skin is absorbed into the body. 1
2. Very little topical clindamycin is absorbed into the body, so it is unlikely to reach breast milk in amounts that could affect a nursing baby, unlike the oral or IV form, which passes into milk in small amounts. 1
3. In a retrospective study of 171 pregnant patients, including 96 using topical clindamycin over 12 weeks, systemic absorption of topical clindamycin was very low and it was considered safe in all trimesters of pregnancy, though a history of gastrointestinal disease should be flagged due to a rare risk of pseudomembranous enterocolitis. 2
4. Topical clindamycin and erythromycin have long been two of the most common first-line prescription acne options in pregnancy, and combining benzoyl peroxide with topical clindamycin has been shown to work better than using either one alone. 3
5. Unlike topical retinoids, which are generally recommended to be avoided during pregnancy, prescription topical antibiotics for acne are handled as a separate, more reassuring category, which is why a prescriber may steer a pregnant patient toward clindamycin instead. 4

Is topical clindamycin safe in each trimester?

• First trimester. First-trimester data specifically comes from a retrospective study of 96 pregnant patients using topical clindamycin, which found systemic absorption very low and the drug considered safe across all trimesters studied.
• Second trimester. Absorption stays minimal through the second trimester too, since very little topical clindamycin crosses into the bloodstream at any point in pregnancy. It's sometimes combined with benzoyl peroxide, which studies show works better for acne than either ingredient used alone.
• Third trimester. If you have a history of gastrointestinal disease, mention it to your prescriber before continuing topical clindamycin in the third trimester or at any point, since the rare risk of pseudomembranous enterocolitis linked to clindamycin calls for that extra caution.