Are Zithromax (azithromycin) and Rocephin (ceftriaxone) safe to use during breastfeeding?

Safety of Zithromax (Azithromycin) and Rocephin (Ceftriaxone) During Breastfeeding

Both Zithromax (azithromycin) and Rocephin (ceftriaxone) are considered safe to use during breastfeeding, with azithromycin classified as "probably safe" and ceftriaxone as "compatible" with breastfeeding according to current guidelines. 1

Azithromycin (Zithromax) Safety During Breastfeeding

• Azithromycin is classified as "probably safe" during breastfeeding according to the European Respiratory Society/Thoracic Society of Australia and New Zealand (ERS/TSANZ) guidelines 1
• The FDA label for azithromycin states that "it is not known whether azithromycin is excreted in human milk" and advises caution when administering to nursing women 2
• There is a very low risk of hypertrophic pyloric stenosis in infants exposed to macrolides during the first 13 days of breastfeeding, but this risk does not persist after 2 weeks 1

Ceftriaxone (Rocephin) Safety During Breastfeeding

• Cephalosporins as a class, including ceftriaxone, are considered "compatible" with breastfeeding 1
• The FDA label notes that "low concentrations of ceftriaxone are excreted in human milk" and recommends caution when administering to nursing women 3
• Ceftriaxone has a longer half-life (7.25 hours) compared to some other cephalosporins, which may increase the risk of accumulation in breast milk 4

Practical Considerations When Using These Antibiotics During Breastfeeding

• For both medications, consider timing administration immediately after breastfeeding to minimize infant exposure 4
• Monitor breastfed infants for:
  • Gastrointestinal effects due to alteration of intestinal flora 5
  • Uncharacteristic symptoms or signs that may indicate adverse reactions 4
• Be aware that antibiotics in breast milk could potentially cause falsely negative cultures if the breastfed infant develops a fever requiring evaluation 5

Important Caveats

• The safety profile assumes:
  • Full-term, healthy infants 1
  • Standard recommended doses and durations of antibiotics 1
  • Exclusive breastfeeding 1
• For premature or otherwise compromised infants, additional caution may be warranted 6
• Most antibiotics have not been shown to cause adverse effects when used during lactation, and temporary interruption of breastfeeding is generally not necessary 7

Conclusion

When comparing these two antibiotics for a breastfeeding mother, ceftriaxone has a slightly better safety profile (classified as "compatible") than azithromycin (classified as "probably safe"), though both are generally considered acceptable during breastfeeding 1. The clinical indication and maternal factors should guide the final selection between these two antibiotics.