From the Guidelines
Doxycycline is considered possibly safe during breastfeeding, particularly for short treatments of 3-4 weeks, according to the most recent evidence 1.
Key Considerations
- The primary concern with doxycycline use during breastfeeding is its potential to affect the infant's developing teeth and bones, as it binds to calcium in these structures.
- Doxycycline may also alter the normal gut flora in the infant, potentially leading to side effects such as thrush (oral candidiasis) or diarrhea.
- Monitoring the infant for these side effects is crucial if a breastfeeding mother must take doxycycline.
- Alternative antibiotics, including penicillins, cephalosporins, and macrolides like azithromycin, are generally considered safer for breastfeeding mothers.
Evidence Summary
The European Respiratory Journal study from 2020 1 suggests that doxycycline is possibly safe during breastfeeding, especially for short-term use. This is consistent with the general caution exercised due to its classification as a tetracycline antibiotic, which can be deposited in growing teeth and bones. Although the amount of doxycycline that transfers into breast milk is relatively small, the potential risks associated with its use have led to a conservative approach in breastfeeding recommendations.
Clinical Implications
Given the potential risks, doxycycline should only be used during breastfeeding if absolutely necessary and for the shortest duration possible 1. Healthcare providers should weigh the benefits of doxycycline treatment against the potential risks to the infant and consider alternative antibiotics whenever possible. If doxycycline is prescribed, close monitoring of the infant for any adverse effects is recommended.
From the FDA Drug Label
Tetracyclines are excreted in human milk; however, the extent of absorption of tetracyclines, including doxycycline, by the breastfed infant is not known Short-term use by lactating women is not necessarily contraindicated; however, the effects of prolonged exposure to doxycycline in breast milk are unknown Because of the potential for serious adverse reactions in nursing infants from doxycycline, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Doxycycline use in breastfeeding is not entirely clear due to the lack of comprehensive data on its effects on the breastfed infant.
- The drug is excreted in human milk, but the extent of absorption by the infant is unknown.
- Short-term use may not be contraindicated, but prolonged exposure could potentially lead to serious adverse reactions in the infant.
- A decision to either discontinue breastfeeding or the drug should be made based on the importance of the drug to the mother 2.
From the Research
Safety of Doxycycline in Breastfeeding
- The safety of doxycycline in breastfeeding is a topic of ongoing debate, with some studies suggesting it may be safe for short courses, while others recommend caution 3.
- A study published in 2019 found that doxycycline binds calcium less avidly than prior tetracyclines, but still recommends selective prescription for breastfeeding women due to limited data 3.
- Another study from 2023 found no association between early childhood exposure to doxycycline and dental staining, suggesting it may be safe at currently recommended dosages 4.
- However, the same study notes that findings regarding antibiotic exposure and developmental defects of enamel or dental caries were inconsistent, and further prospective studies are warranted 4.
- It is worth noting that doxycycline is considered safer than other tetracyclines, and can be used for short courses (<21 days) regardless of age, according to some recommendations 5.
Key Considerations
- The decision to prescribe doxycycline to breastfeeding women should be made on a case-by-case basis, taking into account the potential benefits and risks 3.
- Clinicians should be aware of the limited data available on the safety of doxycycline in breastfeeding women, and consider alternative antibiotics when possible 3.
- Further research is needed to fully understand the effects of doxycycline on dental health and other outcomes in breastfeeding women and their children 4.