From the FDA Drug Label
Based on data on other fluoroquinolones and very limited data on levofloxacin, it can be presumed that levofloxacin will be excreted in human milk. Because of the potential for serious adverse reactions from levofloxacin 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.
Levofloxacin is not considered safe during breastfeeding due to the potential for serious adverse reactions in nursing infants. A decision should be made to either discontinue breastfeeding or discontinue the drug, considering the importance of the drug to the mother 1.
From the Research
Levofloxacin can be considered for use during breastfeeding when clearly indicated, as the data on exposed pregnancies and breastfeeding have not confirmed significant risks, according to the most recent study 2. When considering the use of levofloxacin during breastfeeding, it's essential to weigh the benefits of the medication for the mother against the potential risks to the infant.
- The amount of levofloxacin that passes into breast milk is relatively small, which reduces the risk of adverse effects on the infant.
- However, there are theoretical concerns about potential effects on the infant's developing cartilage and joints based on animal studies with fluoroquinolones.
- A recent study 3 emphasizes the importance of risk assessment and considering the benefits of breastfeeding, the risks of untreated maternal disease, and the maternal willingness to breastfeed.
- The study also highlights that most drugs are transferred from the mother's blood to the milk, but the breastfed infant usually ingests a small amount of the drug through human milk.
- If a mother must take levofloxacin for a serious infection where no safer alternative exists, temporary interruption of breastfeeding during treatment may be considered, but this decision should be made on a case-by-case basis, taking into account the latest evidence and guidelines.
- Monitoring the infant for diarrhea, candidiasis (thrush), or any changes in behavior is crucial if breastfeeding continues during levofloxacin treatment.
- Safer antibiotics, such as penicillins, cephalosporins, or macrolides, should be used instead of levofloxacin for nursing mothers whenever possible, as recommended by the American Academy of Pediatrics and supported by studies like 4.