From the Guidelines
Trimethoprim-sulfamethoxazole (TMP-SMX), clindamycin, and doxycycline are safe oral antibiotic options for treating MRSA infections in breastfeeding mothers. According to the guidelines for the treatment of MRSA infections 1, these antibiotics are effective and have minimal transfer into breast milk. TMP-SMX is generally considered first-line therapy for uncomplicated MRSA infections and is compatible with breastfeeding in healthy, full-term infants. Clindamycin is another effective option, but its use should be exercised with caution in breastfeeding patients due to the potential risk of GI side effects in the infant 1. Doxycycline can be used for short courses in breastfeeding mothers, but there are theoretical concerns about dental staining in infants with prolonged use.
- Key considerations for antibiotic selection include:
- Susceptibility testing of the specific MRSA strain
- Severity and location of the infection
- Mother's medication history
- Treatment duration depends on infection severity, with uncomplicated skin infections typically requiring 7-10 days of therapy, while more complex infections may need longer courses.
- Mothers should be advised to continue breastfeeding during treatment, as the benefits generally outweigh any theoretical risks to the infant.
- The most recent guidelines from 2025 suggest exercising caution when using oral clindamycin in breastfeeding patients 1, but overall, these antibiotics are considered safe for use in breastfeeding mothers.
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 an oral antibiotic that can be used to treat MRSA infections in breastfeeding mothers, 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
Oral MRSA Antibiotics Safe with Breastfeeding
The following oral antibiotics are considered safe for treating Methicillin-Resistant Staphylococcus Aureus (MRSA) infections in breastfeeding mothers:
- Clindamycin: considered relatively safe in the minimal quantities nursing infants ingest through breast milk 3
- Minocycline: often preferred to trimethoprim-sulfamethoxazole or doxycycline for the treatment of community-acquired MRSA skin and soft-tissue infections 4
- Trimethoprim-sulfamethoxazole (TMP-SMX): appears to be relatively safe, but its efficacy has been questioned 3, 5, 6
- Doxycycline: may be used, but its effectiveness is not always predictable 4
- Linezolid, quinupristin-dalfopristin, tigecycline, and daptomycin: limited information is available, but they may be considered safe in the minimal quantities nursing infants ingest through breast milk 3
- Tetracycline: considered relatively safe, but its use is not recommended in children under 8 years old due to the risk of tooth discoloration 3, 7
Key Considerations
When prescribing oral antibiotics for MRSA infections in breastfeeding mothers, it is essential to: