Doxycycline and Breastfeeding
Doxycycline is acceptable for short-term use during breastfeeding because it is present in breast milk at very low concentrations that are unlikely to cause significant adverse effects in nursing infants. 1, 2
Safety Profile
Tetracyclines, including doxycycline, achieve only very low concentrations in breast milk, and the calcium content of breast milk further inhibits absorption by the infant. 1, 2 Key evidence supporting safety includes:
- One study of mothers on steady-state tetracycline dosing found peak breast milk concentrations of only 2.58 mg/L, with undetectable serum levels in their breastfeeding infants 1, 2
- The American Academy of Pediatrics Committee on Drugs classifies tetracycline as "usually compatible with breastfeeding" 2
- Because of these low concentrations, significant adverse reactions in nursing infants are unlikely 1, 2
Clinical Recommendations
Doxycycline should only be prescribed for short-term use with avoidance of repeated courses in nursing mothers. 1, 2, 3 Specific guidance includes:
- The American Academy of Dermatology recommends limiting oral doxycycline use to a maximum of 3 weeks without repeating courses, and using it only when no suitable alternative is available 3
- Doxycycline is now considered acceptable for short-term use even in children aged <8 years, which further supports its safety profile during breastfeeding 1, 2
FDA Labeling Considerations
The FDA drug label states that "short-term use by lactating women is not necessarily contraindicated; however, the effects of prolonged exposure to doxycycline in breast milk are unknown." 4 The label recommends that a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother 4.
Important Caveats
- Most systemic antibiotics present in breast milk could cause falsely negative cultures in febrile infants or produce gastroenteritis due to alteration of intestinal flora 1
- While doxycycline appears relatively safe in the minimal quantities nursing infants ingest through breast milk, close monitoring of breastfed infants is prudent 5
- One review suggests that until more definitive data are developed, doxycycline should continue to be only selectively prescribed for breastfeeding women for whom alternative, safer antibiotics are not available 6
Alternative Antibiotics
If alternatives are needed, consider:
- Amoxicillin/clavulanic acid is classified as compatible with breastfeeding 1, 3
- Azithromycin is classified as "probably safe" (though there is a very low risk of hypertrophic pyloric stenosis in infants exposed during the first 13 days of breastfeeding) 1, 3
- Cephalosporins are considered compatible with breastfeeding 1, 3