Is doxycycline (antibiotic) safe during breastfeeding?

From the Guidelines

Doxycycline is considered safe for short-term use during breastfeeding, with low concentrations found in breast milk and minimal risk of adverse reactions to the infant. According to the most recent and highest quality study 1, tetracyclines, including doxycycline, are present in very low levels in breast milk, and the calcium in breast milk may inhibit absorption by infants. This study suggests that significant adverse reactions are unlikely with short-term use of doxycycline.

The key points to consider when prescribing doxycycline to breastfeeding mothers include:

• Low concentrations of doxycycline in breast milk, reducing the risk of adverse reactions in the infant 1
• Theoretical concerns about dental staining, bone growth effects, and photosensitivity in the breastfed baby, although the actual amount transferred through breast milk is quite small (less than 1% of the maternal dose)
• The American Academy of Pediatrics considers doxycycline compatible with breastfeeding, but most healthcare providers prefer alternative antibiotics when possible
• If doxycycline must be used, the typical adult dose is 100mg twice daily, and mothers should continue breastfeeding but monitor their infant for side effects like diarrhea or thrush

It's also important to note that more recent guidelines 1 recommend limiting the use of oral doxycycline in breastfeeding patients to 3 weeks and without repeating courses, if no suitable alternative antibiotic is available. However, the study from 1 provides more detailed information on the safety of doxycycline during breastfeeding and is considered the highest quality study.

In terms of alternative antibiotics, medications like penicillins, cephalosporins, or macrolides are generally considered safer first-line options when clinically appropriate for the infection being treated. Ultimately, the decision to use doxycycline during breastfeeding should be made on a case-by-case basis, taking into account the specific clinical situation and the potential risks and benefits of treatment.

From the FDA Drug Label

Tetracyclines are excreted in human milk; however, the extent of absorption of tetracyclines, including doxycycline, by the breastfed infant is not known Short-term use by lactating women is not necessarily contraindicated; however, the effects of prolonged exposure to doxycycline in breast milk are unknown Because of the potential for serious adverse reactions in nursing infants from doxycycline, 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.

Doxycycline safety during breastfeeding is uncertain due to the potential for serious adverse reactions in nursing infants.

• The extent of absorption of doxycycline by the breastfed infant is not known.
• Short-term use may not be contraindicated, but prolonged exposure effects are unknown. A decision should be made to either discontinue nursing or the drug, considering the drug's importance to the mother 2.

From the Research

Safety of Doxycycline During Breastfeeding

• The safety of doxycycline during breastfeeding is a concern due to its classification as a tetracycline antibiotic, which can cause fetal tooth discoloration and inhibition of bone growth if used in the second and third trimesters 3.
• However, doxycycline is considered to be safer than other tetracyclines, as it binds calcium less avidly, and some authorities regard it as safe to prescribe for pregnant women and young children 4.
• The use of doxycycline in breastfeeding women is not well-studied, but most antibiotics, including doxycycline, are secreted into breast milk in very small amounts, not enough to have any therapeutic effect 3.
• There is limited evidence to suggest that doxycycline is safe for use in breastfeeding women, but it should be used with caution and only when alternative, safer antibiotics are not available 4.

Potential Risks to the Infant

• The main concern with using doxycycline during breastfeeding is the potential risk of tooth discoloration and inhibition of bone growth in the infant, although this risk is considered to be low 3, 4.
• Studies have shown that doxycycline use in children under 8 years of age does not seem to induce permanent tooth staining 5, 6.
• However, the use of doxycycline in breastfeeding women may still pose a risk to the infant, and its use should be carefully considered and monitored 4, 7.

Recommendations for Use

• Doxycycline should be used with caution in breastfeeding women and only when alternative, safer antibiotics are not available 4.
• The duration of treatment should be as short as possible to minimize the risk of adverse effects in the infant 4.
• Breastfeeding women who require doxycycline treatment should be closely monitored for any signs of adverse effects in the infant, and alternative antibiotics should be considered if possible 3, 7.