From the Guidelines
Breastfeeding mothers with urinary tract infections (UTIs) can be safely treated with antibiotics such as amoxicillin, cephalexin, or trimethoprim-sulfamethoxazole, as these medications have a low risk of harming the infant and are effective against common UTI-causing bacteria. When choosing an antibiotic, it is essential to consider the susceptibility of the uropathogen and local resistance patterns 1. According to the evidence, oral trimethoprim-sulfamethoxazole (160/800 mg twice-daily for 14 days) is an appropriate choice for therapy if the uropathogen is known to be susceptible 1.
Some key points to consider when treating UTIs in breastfeeding mothers include:
- Ensuring adequate hydration to help flush out the bacteria
- Completing the full course of medication, even if symptoms improve, to prevent recurrence and reduce the risk of antibiotic resistance
- Monitoring for potential side effects in both the mother and infant, such as diarrhea or thrush
- Consulting with a healthcare provider to determine the best course of treatment based on individual patient factors and local resistance patterns
It's also important to note that most systemic antibiotics will be present in breast milk, but the amounts are usually very small and not harmful to most infants 1. However, mothers should be aware of the potential risks and monitor their infant for any unusual symptoms.
In terms of specific medication options, the following are considered safe for breastfeeding mothers:
- Amoxicillin (A) 1
- Cephalexin (B1) 1
- Trimethoprim-sulfamethoxazole (C) 1
- Azithromycin (B1) 1
- Ciprofloxacin (B3) 1, although this should be used with caution due to potential risks to the infant.
Ultimately, the choice of antibiotic will depend on the specific circumstances of the patient and the susceptibility of the uropathogen, and should be made in consultation with a healthcare provider.
From the FDA Drug Label
Levels of sulfamethoxazole and trimethoprim in breast milk are approximately 2% to 5% of the recommended daily dose for infants over 2 months of age Caution should be exercised when sulfamethoxazole and trimethoprim is administered to a nursing woman, especially when breastfeeding jaundiced, ill, stressed, or premature infants because of the potential risk of bilirubin displacement and kernicterus
Safe Medications for UTI in Breastfeeding Mother:
- Sulfamethoxazole and trimethoprim can be used with caution in breastfeeding mothers.
- The medication is secreted in breast milk at levels of approximately 2% to 5% of the recommended daily dose for infants over 2 months of age.
- Caution is advised, especially when breastfeeding jaundiced, ill, stressed, or premature infants, due to the potential risk of bilirubin displacement and kernicterus 2
From the Research
Safe Medications for UTI in Breastfeeding Mothers
- The following medications are considered safe for breastfeeding mothers with UTI:
- These medications have minimal collateral damage and resistance, and are recommended as first-line treatments for UTI in breastfeeding mothers.
- Fluoroquinolones, such as ciprofloxacin and levofloxacin, are not recommended due to high resistance rates and potential side effects 4, 6.
- It is essential to note that the choice of medication should be based on the specific circumstances of the patient, including the severity of the infection, the presence of any underlying medical conditions, and the results of urine culture and sensitivity testing 3, 5.
Considerations for Breastfeeding Mothers
- Breastfeeding mothers should consult their healthcare provider before taking any medication for UTI.
- The healthcare provider will consider the safety of the medication for the breastfeeding infant and the effectiveness of the medication in treating the UTI.
- Monitoring of the infant for any potential side effects of the medication is also recommended 5.