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

From the Guidelines

Breastfeeding mothers with a leg abscess can be safely treated with antibiotics such as cephalexin, dicloxacillin, or amoxicillin-clavulanate, and for MRSA infections, trimethoprim-sulfamethoxazole or clindamycin can be used, as recommended by the Infectious Diseases Society of America guidelines 1.

Key Considerations

• The primary treatment for a leg abscess is incision and drainage, and antibiotics should be used as an adjunct therapy in certain cases, such as severe or extensive disease, systemic illness, or lack of response to incision and drainage alone 1.
• For breastfeeding mothers, it is essential to choose antibiotics that are safe and have minimal transfer into breast milk.
• The recommended antibiotics for breastfeeding mothers with a leg abscess include:
  • Cephalexin (500mg four times daily) 1
  • Dicloxacillin (500mg four times daily) 1
  • Amoxicillin-clavulanate (875/125mg twice daily) 1
  • Trimethoprim-sulfamethoxazole (one double-strength tablet twice daily) for MRSA infections 1
  • Clindamycin (300-450mg three times daily) for MRSA infections, although it carries a small risk of causing diarrhea in the infant 1

Important Notes

• The mother should complete the full course of antibiotics even if symptoms improve quickly.
• It is crucial to stay well-hydrated and watch for any unusual reactions in the baby, such as rash, diarrhea, or irritability.
• These antibiotics are considered safe because they have poor oral bioavailability in infants and/or are poorly absorbed from breast milk, meaning minimal amounts reach the nursing infant.

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 can be used in a breastfeeding mother with a leg abscess, but it is recommended to monitor the breast-fed infant for possible adverse effects on the gastrointestinal flora, such as diarrhea or candidiasis. An alternate drug may be preferred 2.

From the Research

Antibiotic Options for Breastfeeding Mother with Leg Abscess

• The choice of antibiotic for a breastfeeding mother with a leg abscess depends on the causative organism and its susceptibility pattern 3, 4, 5.
• For methicillin-susceptible Staphylococcus aureus (MSSA) infections, penicillinase-resistant penicillins (flucloxacillin, dicloxacillin) are the antibiotics of choice, but first-generation cephalosporins (cefazolin, cephalothin, and cephalexin), clindamycin, lincomycin, and erythromycin can also be used 3.
• For methicillin-resistant Staphylococcus aureus (MRSA) infections, clindamycin, sulfonamide, and tetracycline antibiotics are valuable agents, but linezolid and newer parenteral antibiotics should be reserved for serious infections 4, 6.
• In the case of a breastfeeding mother, it is essential to consider the safety of the antibiotic in the infant, and clindamycin, rifampin, tetracyclines, trimethoprim-sulfamethoxazole, and vancomycin appear to be relatively safe in the minimal quantities nursing infants ingest through breast milk 5.

Safety of Antibiotics in Breastfeeding Infants

• The safety of antibiotics in breastfeeding infants has been evaluated, and most antibiotics used to treat MRSA infections appear to be relatively safe, but close monitoring of the infant is recommended 5.
• Clindamycin, in particular, has been shown to be effective against MRSA and is considered safe for use in breastfeeding mothers 4, 5.

Empirical Antibiotic Therapy

• Empirical antibiotic therapy for a breastfeeding mother with a leg abscess should be guided by the institutional antibiogram and should cover MRSA, as it is a common causative organism in skin and soft tissue infections 4.
• Ciprofloxacin with clindamycin can be considered as initial empirical therapy, but the choice of antibiotic should be tailored to the individual patient and the suspected causative organism 4.