From the Guidelines
Doxycycline can be prescribed during breastfeeding for short courses, typically 3 weeks or less, as the risk to the infant is considered minimal due to low concentrations in breast milk and reduced bioavailability. When prescribed, the typical adult dosage is 100mg twice daily, with the recommendation to take it with food to reduce stomach upset 1. The medication binds to calcium in milk, limiting infant absorption, and the infant's gut absorbs very little of the drug 1. However, for longer courses, alternative antibiotics like penicillins or cephalosporins are preferred when appropriate for the infection being treated. Mothers should monitor their infants for potential side effects such as thrush or diaper rash, though these are uncommon with short-term maternal use. It's also advisable to time the medication doses right after breastfeeding to minimize the amount in milk during the next feeding. Some key points to consider when prescribing doxycycline during breastfeeding include:
- The drug is excreted into breast milk at low levels, but the extent of absorption by nursing infants is unknown 1
- Short-term use of doxycycline is considered probably safe during lactation on the basis of available literature and expert opinion 1
- Tetracycline, a related drug, is listed by the American Academy of Pediatrics Committee on Drugs as “usually compatible with breastfeeding” 1
- Doxycycline should be limited to 3 weeks and without repeating courses, if no suitable alternative antibiotic is available 1
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 use during breastfeeding is not strictly contraindicated for short-term use, but the effects of prolonged exposure to doxycycline in breast milk are unknown. Due to the potential for serious adverse reactions in nursing infants, a decision should be made to either discontinue nursing or discontinue the drug, considering the importance of the drug to the mother 2.
From the Research
Doxycycline and Breastfeeding
- The use of doxycycline during breastfeeding is a topic of consideration due to its classification as a tetracycline antibiotic 3.
- Tetracyclines are known to bind calcium and can cause permanent dental staining in young children, which has led to caution in prescribing them to pregnant or breastfeeding women 3.
- However, doxycycline is considered to bind calcium less avidly than other tetracyclines, leading some authorities to regard it as safer for use in pregnant women and young children 3.
- Despite this, a review of available data suggests that doxycycline should only be prescribed to breastfeeding women when alternative, safer antibiotics are not available, and treatment courses should be as short as possible 3.
- Other studies have evaluated the safety of various antibiotics, including doxycycline, during lactation, suggesting that while there may be some risk, the quantities of these drugs in breast milk are generally considered to be relatively safe for nursing infants 4.
- The safety of medications during breastfeeding is a complex issue, and resources like LactMed provide valuable information on the safety of various drugs, including antibiotics like doxycycline, during lactation 5.
- General guidelines for antibiotic use during pregnancy and lactation emphasize the importance of weighing the benefits and risks, with penicillins and cephalosporins often being first-line treatments, and tetracyclines, including doxycycline, typically being avoided due to potential risks 6.
- In specific scenarios, such as the treatment of anthrax, doxycycline may be recommended for antimicrobial prophylaxis and treatment, including in children and breastfeeding mothers, although alternatives like amoxicillin may be preferred in certain cases 7.