What are the preferred antibiotics for a lactating mother with a complicated Urinary Tract Infection (UTI)?

From the Guidelines

For lactating mothers with complicated urinary tract infections (UTIs), the preferred antibiotics include a combination of amoxicillin plus an aminoglycoside or a second-generation cephalosporin plus an aminoglycoside, as recommended by the European Association of Urology guidelines 1. When considering the treatment of complicated UTIs in lactating mothers, it's crucial to prioritize the safety of both the mother and the infant.

• The European Association of Urology guidelines suggest using a combination of antibiotics, such as amoxicillin plus an aminoglycoside or a second-generation cephalosporin plus an aminoglycoside, for the treatment of complicated UTIs 1.
• Additionally, an intravenous third-generation cephalosporin can be used as empirical treatment for complicated UTI with systemic symptoms 1.
• However, ciprofloxacin and other fluoroquinolones should be avoided for empirical treatment of complicated UTI in patients from urology departments or when patients have used fluoroquinolones in the last 6 months, unless the local resistance rate is <10% and the patient does not require hospitalization 1.
• It's also essential to manage any urological abnormality and/or underlying complicating factors 1.
• The choice of antibiotic should ultimately be guided by urine culture results and local resistance patterns, and any concerning symptoms like high fever, flank pain, or vomiting warrant immediate medical attention as they may indicate progression to pyelonephritis.
• Adequate hydration and urination after breastfeeding can help flush bacteria from the urinary tract.
• Treatment duration for complicated UTIs typically ranges from 7-14 days depending on severity, and it's essential that the full course of antibiotics be completed even if symptoms resolve earlier.

From the Research

Preferred Antibiotics for Lactating Mothers with Complicated UTI

• The choice of antibiotics for lactating mothers with complicated Urinary Tract Infections (UTIs) should be based on the safety of the drug for the infant and the effectiveness of the treatment for the mother 2, 3, 4.
• According to the available evidence, penicillins, aminopenicillins, clavulanic acid, cephalosporins, macrolides, and metronidazole are considered compatible with breastfeeding 4.
• Fluoroquinolones, such as ciprofloxacin and levofloxacin, are generally considered safe for use during lactation, but their use should be cautious and reserved for cases where other options are not suitable 2, 4.
• Amoxicillin/clavulanic acid and cefuroxime have been studied for their safety during lactation, and the results suggest that they may be safe, but larger studies are needed to confirm these findings 5.
• For complicated UTIs, the treatment options may include nitrofurantoin, fosfomycin, pivmecillinam, fluoroquinolones, and beta-lactam antibiotics, such as amoxicillin-clavulanate and cefixime 6.

Considerations for Antibiotic Use in Lactating Mothers

• The risks of medication use for lactating mothers are unique, and healthcare professionals should consider the teratogenic and toxic risk profiles of antibiotics when making prescribing decisions 2.
• The majority of antibiotics are considered compatible with breastfeeding, but the decision to use a particular antibiotic should be based on accurate and up-to-date information 4.
• The use of antibiotics during lactation should be carefully monitored, and the infant should be observed for any signs of adverse effects 5.