What antibiotics are safe during breastfeeding (lactation)?

From the Guidelines

Most antibiotics are safe during breastfeeding, including penicillins, cephalosporins, and macrolides, as they enter breast milk in small amounts that are not harmful to most infants. When considering the safety of antibiotics during lactation, it's essential to weigh the benefits and risks, prioritizing the health and well-being of both the mother and the infant 1.

Key Considerations

• Penicillins, such as amoxicillin, and cephalosporins are generally considered safe during breastfeeding, with minimal risk of adverse effects on the infant 1.
• Macrolides, including azithromycin, are also safe, although there is a very low risk of hypertrophic pyloric stenosis in infants exposed to macrolides during the first 13 days of breastfeeding 1.
• Certain antibiotics, such as ciprofloxacin, tetracyclines (doxycycline), and sulfonamides, should be avoided or used with caution, especially in premature infants or those with G6PD deficiency or hyperbilirubinemia 1.

Monitoring and Precautions

• Mothers should inform their healthcare provider that they are breastfeeding when antibiotics are prescribed, allowing the provider to select the safest option and appropriate dosing 1.
• When taking antibiotics while breastfeeding, mothers should watch for potential side effects in their infants, such as diarrhea, thrush, or skin rash 1.
• The safety profile of antibiotics during breastfeeding depends on the specific antibiotic, the infant's age and health status, and the duration of treatment 1.

Recommendations

• Amoxicillin, azithromycin, and cefuroxime are considered safe options for breastfeeding mothers, as they have a low risk of adverse effects on the infant 1.
• Ciprofloxacin, doxycycline, and sulfonamides should be avoided or used with caution, due to the potential risks of adverse effects on the infant 1.
• Mothers should always consult their healthcare provider before taking any antibiotic while breastfeeding, to ensure the safest option is chosen and potential risks are minimized 1.

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 considered relatively safe during breastfeeding, but monitoring of the infant for adverse effects is recommended.
• The decision to use clindamycin during lactation should be based on the mother's clinical need and the potential risks to the infant.
• An alternate drug may be preferred to minimize potential adverse effects on the breast-fed infant 2

From the Research

Antibiotics Safe During Breastfeeding

• Most antibiotics in clinical use are considered suitable during breastfeeding, but the pharmacokinetic profile of each drug must be observed to ensure the resolution of the maternal infection and the safety of the infant 3
• The use of most antibiotics is considered compatible with breast feeding, including:
  • Penicillins
  • Aminopenicillins
  • Clavulanic acid
  • Cephalosporins
  • Macrolides
  • Metronidazole (at dosages at the low end of the recommended dosage range) 4
• Fluoroquinolones should not be administered as first-line treatment, but if they are indicated, breast feeding should not be interrupted because the risk of adverse effects is low and the risks are justified 4
• Antibiotics such as clindamycin, daptomycin, linezolid, quinupristin-dalfopristin, rifampin, tetracycline, doxycycline, minocycline, tigecycline, trimethoprim-sulfamethoxazole, and vancomycin appear to be relatively safe in the minimal quantities nursing infants ingest through breast milk 5

General Principles for Antibiotic Use During Breastfeeding

• The necessity of prescribing to breast feeding mothers should be questioned, and the advantages and disadvantages should be carefully assessed for both mother and baby 6
• The use of drugs with short half lives minimises the risk of accumulation, and advising the administration of medication immediately following a breast feed is the safest option for the baby 6
• All infants should be monitored for uncharacteristic symptoms and signs, and if it is essential that a drug with known potential serious toxicity to the infant has to be prescribed to the mother, then breast feeding should be discontinued 6