Is doxycycline (antibiotic) safe to use during breastfeeding?

Doxycycline Use During Breastfeeding

Doxycycline can be used during breastfeeding for short-term treatment (up to 3-4 weeks) without repeating courses, as tetracyclines are present in breast milk at very low levels and calcium in breast milk likely inhibits infant absorption. 1, 2

Primary Recommendation

For breastfeeding patients requiring systemic antibiotics, limit oral doxycycline use to 3 weeks maximum without repeating courses. 1 This represents the most recent (2025) high-quality guideline consensus from the Journal of the American Academy of Dermatology.

Safety Evidence Supporting Use

• Tetracyclines reach only very low concentrations in breast milk, with one study showing peak breast milk levels were minimal and the drug was undetectable in breastfed infant serum. 3

• Calcium in breast milk may inhibit tetracycline absorption by the infant, providing an additional protective mechanism. 3, 2

• The American Academy of Pediatrics Committee on Drugs lists tetracycline as "usually compatible with breastfeeding." 3

• Short-term use by lactating women is not necessarily contraindicated according to FDA labeling, though effects of prolonged exposure remain unknown. 2

Duration Limits and Key Restrictions

• Maximum treatment duration: 3-4 weeks 1
• Avoid repeated courses 1
• Effects of prolonged exposure to doxycycline in breast milk are unknown, necessitating caution with extended therapy. 2

Clinical Decision Algorithm

Use doxycycline when:

• Short-term treatment (≤3 weeks) is sufficient 1
• Alternative safer antibiotics are inadequate or unavailable 1
• The infant is healthy, full-term, and not premature 1

Avoid doxycycline when:

• Treatment would require >3-4 weeks 1
• Repeated courses would be necessary 1
• The infant is premature, jaundiced, or has G6PD deficiency (though this applies more to sulfonamides) 1
• Safer alternatives like amoxicillin/clavulanic acid, macrolides, or metronidazole are appropriate 1

Preferred Alternative Antibiotics During Breastfeeding

First-line alternatives with stronger safety profiles:

• Amoxicillin/clavulanic acid (suggested as preferred option) 1
• Erythromycin or azithromycin (macrolides are suggested, though very low risk of infantile hypertrophic pyloric stenosis exists in first 13 days) 1
• Metronidazole (suggested as safe based on cohort data) 1

Exercise caution with:

• Clindamycin (may increase GI side effects in infant) 1

Important Caveats

• Doxycycline is contraindicated during pregnancy (Category D), particularly in second and third trimesters due to tooth discoloration and bone growth suppression, but breastfeeding represents a different risk profile. 1

• Do not confuse doxycycline with other tetracyclines (tetracycline, minocycline, oxytetracycline), which have different safety profiles. 4

• The 2017 British Thoracic Society guidelines list breastfeeding as a contraindication 1, but this represents older, more conservative guidance that has been superseded by 2025 guidelines showing short-term use is acceptable. 1

• Significant adverse reactions in nursing infants are unlikely due to low tetracycline concentrations in breast milk. 3

Risk-Benefit Consideration

For life-threatening maternal infections where doxycycline is first-line therapy, the benefits clearly outweigh potential risks to the breastfed infant. 3 However, for routine infections, prioritize alternative antibiotics with more established breastfeeding safety data. 1