What antibiotic eye drop is safe to use during lactation (nursing)?

From the Guidelines

Erythromycin ophthalmic ointment is the safest antibiotic eyedrop option for use during nursing, due to its minimal systemic absorption and low risk of passing into breast milk in significant amounts. According to the most recent evidence 1, topical antibiotics such as erythromycin and tobramycin have been shown to provide symptomatic relief and decrease bacteria from the eyelid margin in cases of anterior blepharitis. Other relatively safe options include polymyxin B combinations and ciprofloxacin ophthalmic preparations. When using antibiotic eyedrops while nursing, proper administration technique is crucial:

• Wash hands before application
• Pull down the lower eyelid to create a pocket for the medication
• Avoid touching the dropper tip to any surface
• Apply gentle pressure to the inner corner of the eye after administration to prevent drainage into the tear duct. The safety profile of these medications during breastfeeding is based on their limited systemic absorption through the eye and the small amount of medication that would potentially reach breast milk, as supported by previous studies 1. However, it's always best to consult with your healthcare provider before using any medication while nursing, as individual circumstances may affect recommendations.

From the FDA Drug Label

In nursing women a single 200 mg oral dose resulted in concentrations of ofloxacin in milk which were similar to those found in plasma. It is not known whether ofloxacin is excreted in human milk following topical ophthalmic administration Because of the potential for serious adverse reactions from ofloxacin in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. It is not known whether topically applied ciprofloxacin is excreted in human milk. However, it is known that orally administered ciprofloxacin is excreted in the milk of lactating rats and oral ciprofloxacin has been reported in human breast milk after a single 500 mg dose. Caution should be exercised when Ciprofloxacin ophthalmic solution 0. 3% is administered to a nursing mother.

Neither ofloxacin nor ciprofloxacin is explicitly safe for use during nursing, as both labels advise caution due to potential excretion into breast milk and possible adverse effects on nursing infants 2 3.

• Ofloxacin: The label recommends considering discontinuation of either nursing or the drug.
• Ciprofloxacin: The label advises caution when administering to a nursing mother. No conclusion can be drawn regarding the safety of these antibiotic eyedrops during nursing.

From the Research

Antibiotic Eyedrops Safe for Nursing

There are no specific studies provided that directly address the safety of antibiotic eyedrops during nursing. However, we can look at the general safety and efficacy of various antibiotics mentioned in the studies.

Safety and Efficacy of Antibiotics

• The study 4 compared the resistance patterns of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA) keratitis isolates with common topically applied ophthalmic antimicrobials.
• Vancomycin was found to be effective against MRSA, while MRSA demonstrated significant resistance to other antibiotics, including fluoroquinolones 4.
• The study 5 evaluated the activity of ciprofloxacin, ofloxacin, levofloxacin, and erythromycin against Legionella species, finding that quinolones were highly active against these species.
• The study 6 found significant variability in group B Streptococcus antibiotic resistance rates, with high resistance rates observed for tetracycline and low resistance rates for tedizolid.

Considerations for Nursing

• When considering the use of antibiotic eyedrops during nursing, it is essential to consult with a healthcare professional to determine the safest and most effective option.
• The studies provided do not specifically address the safety of antibiotic eyedrops during nursing, but they do highlight the importance of considering antibiotic resistance patterns when selecting a treatment option 4, 6.