From the Guidelines
The most appropriate antibiotics for treating hidradenitis suppurativa (HS) while breastfeeding are amoxicillin/clavulanic acid, clindamycin, and short-term doxycycline, as they have been deemed safe based on limited data and expert opinion 1. When considering treatment options, it's essential to weigh the benefits of treating HS against potential risks to the nursing infant.
- Amoxicillin/clavulanic acid is suggested for use in breastfeeding patients with HS who require systemic antibiotics 1.
- Clindamycin is safe but may cause gastrointestinal effects in infants, and its use should be exercised with caution 1.
- Short-term doxycycline use is recommended to be limited to 3 weeks and without repeating courses 1.
- Other antibiotics like rifampin and metronidazole are also considered safe based on limited data and expert opinion 1.
- Tetracyclines like minocycline are generally acceptable for short-term use while breastfeeding, though prolonged use should be avoided as they can potentially affect bone development and cause tooth discoloration in the infant.
- Trimethoprim-sulfamethoxazole can be used if the infant is healthy and full-term but should be avoided if the baby is premature or has G6PD deficiency. Before starting any antibiotic treatment, it's crucial to discuss with both your dermatologist and pediatrician to determine the best course of action for your specific situation, taking into account the severity of your HS and the potential risks to your nursing infant 1. The timing of medication relative to breastfeeding sessions can also be adjusted to minimize infant exposure, typically taking the medication immediately after nursing.
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 for hidradenitis suppurativa (HS) while breast-feeding, but it is recommended to monitor the breast-fed infant for possible adverse effects on the gastrointestinal flora, such as diarrhea, candidiasis, or rarely, blood in the stool. An alternate drug may be preferred 2.
From the Research
Antibiotic Treatment for Hidradenitis Suppurativa while Breast-Feeding
- The safety of antibiotics during breast-feeding is a crucial consideration for treating hidradenitis suppurativa (HS) in lactating women.
- According to the studies, the following antibiotics have been used to treat HS:
- Clindamycin: effective in combination with rifampicin for severe HS 3, 4
- Rifampicin: a key component in the antibiotic treatment of HS, effective against bacteria, bacterial biofilms, and the human immune system 4
- Doxycycline: commonly used antibiotic for HS, but its effectiveness during breast-feeding is not well-studied 5
- Penicillins with β-lactamase inhibitors and fluoroquinolones: may serve as first-line therapy for HS, but their safety during breast-feeding needs to be considered 5
- For breast-feeding women, it is essential to choose antibiotics that are safe for the infant.
- Topical antibiotics, such as clindamycin 1% or resorcinol 15%, may be a viable alternative to systemic antibiotics for mild-to-moderate HS 6.
- Clindamycin mono-therapy has been shown to be effective in some patients with HS, but the prevalence of clindamycin resistance and the safety of this treatment during breast-feeding need to be considered 7.
- It is crucial to consult a healthcare professional to determine the best course of treatment for HS while breast-feeding, taking into account the severity of the disease, the safety of the antibiotic, and the potential risks to the infant 3, 4, 5, 6, 7.