Meropenem Use During Breastfeeding
Meropenem is safe to use during breastfeeding, with minimal transfer into breast milk and no reported adverse effects in breastfed infants. 1, 2
Evidence for Safety
Meropenem has been specifically classified as "possibly safe" and "probably safe" for use during breastfeeding according to the European Respiratory Society/Thoracic Society of Australia and New Zealand (ERS/TSANZ) task force statement 1. This recommendation is supported by clinical evidence showing:
- The amount of meropenem transferred into breast milk is very low
- In a case study, the maximum concentration in breast milk was only 0.64 μg/mL 2
- The calculated infant daily exposure was just 97 μg/kg/day, representing only 0.18% of the weight-adjusted maternal dose 2
- No dermatologic or gastrointestinal side effects were observed in the breastfed infant 2
Pharmacokinetic Considerations
Several factors contribute to meropenem's safety profile during lactation:
- As a beta-lactam antibiotic, meropenem has low oral bioavailability
- Even if present in breast milk, much of the drug would not be absorbed by the infant's gastrointestinal tract
- The drug has a relatively short half-life, which limits accumulation
Clinical Recommendations
When meropenem is needed for maternal treatment:
- No interruption of breastfeeding is necessary
- No special monitoring of the infant is required
- The benefits of treating the maternal infection outweigh the minimal risks to the breastfed infant
Important Considerations
- While meropenem is safe during breastfeeding, it should only be used when clinically indicated for serious infections, as it is a broad-spectrum antibiotic typically reserved for more severe cases
- As with all antibiotics during breastfeeding, be aware that:
- Theoretical concerns exist about potential effects on infant gut flora
- There is a small possibility of allergic reactions, though this risk is minimal
Comparison with Other Antibiotics
For context, most antibiotics are considered compatible with breastfeeding, with guidelines noting that "short courses of antibiotics are commonly used peri-operatively" with "no evidence of harmful effects in breastfeeding women" 1.
For severe infections requiring broad-spectrum coverage, meropenem represents a safe option that allows continuation of breastfeeding while effectively treating maternal infection.