What antibiotics are safe for a breastfeeding mother with an abscess?

From the Guidelines

Breastfeeding mothers with an abscess can safely use oral azithromycin as a first-line antibiotic option. This recommendation is based on the most recent and highest quality study available, which suggests using oral azithromycin in breastfeeding patients with hidradenitis suppurativa who require systemic antibiotics 1.

When considering antibiotic treatment for a breastfeeding mother with an abscess, it's essential to prioritize options that are compatible with breastfeeding, minimizing the risk to the infant. The primary goal is to effectively treat the infection while ensuring the safety and well-being of both the mother and the baby.

Key considerations for antibiotic selection in this context include:

• The antibiotic's efficacy against the suspected or confirmed causative pathogens
• The degree to which the antibiotic is excreted in breast milk
• The potential impact of the antibiotic on the infant's gut flora
• The safety profile of the antibiotic for the mother and the infant

Given these considerations and based on the latest clinical practice guidelines 1, oral azithromycin is recommended for breastfeeding mothers with an abscess, as it is considered safe and effective, with minimal transfer into breast milk and minimal effects on the infant's gut flora. Treatment should be accompanied by continued breastfeeding or pumping from the affected breast, adequate pain management, and possibly drainage of the abscess if it's large. The choice of antibiotic may be adjusted based on culture results if available, and the full course should be completed even if symptoms improve quickly.

From the FDA Drug Label

Nursing Mothers Limited published data based on breast milk sampling reports that clindamycin appears in human breast milk in the range of less than 0.5 to 3. 8 mcg/mL. Clindamycin has the potential to cause adverse effects on the breast-fed infant's gastrointestinal flora. If oral or intravenous clindamycin is required by a nursing mother, it is not a reason to discontinue breastfeeding, but an alternate drug may be preferred Monitor the breast-fed infant for possible adverse effects on the gastrointestinal flora, such as diarrhea, candidiasis (thrush, diaper rash) or rarely, blood in the stool indicating possible antibiotic-associated colitis

Clindamycin is a possible option for a breastfeeding mother with an abscess, but it is recommended to monitor the breast-fed infant for possible adverse effects on the gastrointestinal flora. The decision to use clindamycin should be based on the mother's clinical need and the potential risks to the infant 2.

From the Research

Antibiotics for Abscess while Breastfeeding

• The use of antibiotics in breastfeeding mothers with an abscess is a common practice, with the goal of treating the infection while minimizing the risk to the infant 3, 4, 5.
• According to studies, many antibiotics are secreted in milk, but penicillin, cephalosporins, and erythromycin are considered safe for use during breastfeeding 3.
• The choice of antibiotic should be based on the suspected or confirmed causative organism, with Staphylococcus aureus being a common cause of breast abscesses 6, 5.
• Some studies recommend the use of antibiotics such as ciprofloxacin and clindamycin as initial empirical therapy for breast abscesses, especially in cases where methicillin-resistant Staphylococcus aureus (MRSA) is suspected 6.
• It is essential to note that the use of antibiotics during breastfeeding should be carefully assessed, and the advantages and disadvantages should be weighed for both the mother and the baby 7.
• Breastfeeding can usually continue in the presence of a treated abscess, and mothers should be encouraged to continue breastfeeding to prevent the cessation of lactation 4, 5.

Safe Antibiotics for Breastfeeding Mothers

• Penicillin
• Cephalosporins
• Erythromycin
• Ciprofloxacin
• Clindamycin
• Dicloxacillin
• Cephalexin

Considerations for Antibiotic Use during Breastfeeding

• The necessity of prescribing antibiotics to breastfeeding mothers should be questioned, and the advantages and disadvantages should be carefully assessed 7.
• The use of drugs with short half-lives minimizes the risk of accumulation, and advising the administration of medication immediately following a breast feed is the safest option for the baby 7.
• All infants should be monitored for uncharacteristic symptoms and signs, and breastfeeding should be discontinued if a drug with known potential serious toxicity to the infant has to be prescribed to the mother 7.