Can women breastfeed while taking ertapenem?

Breastfeeding While Taking Ertapenem

Women can continue breastfeeding while taking ertapenem, as the drug is present in breast milk at low levels with no documented adverse effects on breastfed infants. 1

Evidence on Ertapenem in Breast Milk

The FDA drug label provides the most definitive information on ertapenem use during breastfeeding:

• Ertapenem is present in human breast milk, but at low concentrations 1
• In a study of 5 lactating women with pelvic infections (5-14 days postpartum):
  • Breast milk concentrations within 24 hours of the last dose ranged from <0.13 to 0.38 mcg/mL
  • By day 5 after discontinuation, ertapenem was undetectable in 4 women and below quantitation limit in 1 woman 1

Risk-Benefit Assessment

When considering ertapenem use during breastfeeding, several factors support continued breastfeeding:

1. Low infant exposure: The amount of ertapenem transferred to breast milk is minimal
2. Poor oral bioavailability: As with many antibiotics, ertapenem likely has poor oral bioavailability in infants, further reducing systemic exposure
3. Benefit preservation: The Association of Anaesthetists guidelines emphasize the importance of maintaining breastfeeding when possible, as temporary interruption can disrupt the nursing relationship 2, 3

Clinical Recommendations

• Continue breastfeeding: The developmental and health benefits of breastfeeding outweigh the potential minimal risks from ertapenem exposure through breast milk 1
• Monitor the infant: While no specific adverse effects have been documented, general monitoring for unusual drowsiness, feeding difficulties, or gastrointestinal disturbances is prudent
• No need to "pump and dump": Unlike some medications that require temporary cessation of breastfeeding, ertapenem does not require discarding breast milk 2, 1

Comparison to Other Antibiotics

The Association of Anaesthetists guidelines note that "short courses of antibiotics are commonly used peri-operatively. There is no evidence of harmful effects in breastfeeding women." 2 This general principle applies to ertapenem as well.

Important Considerations

• Ertapenem is administered once daily (1g), which is advantageous for breastfeeding mothers compared to antibiotics requiring multiple daily doses 4
• If the mother has renal impairment (creatinine clearance ≤30 mL/min), dose adjustment is necessary, which could potentially affect milk concentrations 1
• The concentration of ertapenem observed in transitional milk may not reflect the concentration in mature milk 1

By following these recommendations, mothers can receive necessary antibiotic treatment with ertapenem while continuing to provide the benefits of breastfeeding to their infants.