Cefixime Safety in Breastfeeding Mothers
Cefixime can be used during breastfeeding, though consideration should be given to temporarily discontinuing nursing during treatment, as excretion into human milk is unknown and data are limited.
FDA Drug Label Guidance
The official FDA prescribing information for cefixime explicitly states: "It is not known whether cefixime is excreted in human milk. Consideration should be given to discontinuing nursing temporarily during treatment with this drug" 1. This represents the most authoritative source but reflects the lack of specific human lactation data for cefixime.
Class-Based Safety Evidence
β-lactam antibiotics as a class, including cephalosporins, are commonly used and overall thought to be safe during lactation 2. The Mayo Clinic guidelines from 2025 specifically note that β-lactam antibiotics are generally safe, in contrast to tetracyclines and fluoroquinolones which should be avoided 2.
Cephalosporin-Specific Data:
- Ceftazidime and ceftriaxone (other third-generation cephalosporins like cefixime) are classified as "compatible" with breastfeeding 2, 3
- Most studies found that cephalosporin antibiotics in general are safe to use during lactation, with low presence in breast milk 2
- Cephalosporins including cephalexin and ceftriaxone are considered compatible by the European Respiratory Society 3
Pharmacokinetic Considerations
Research indicates that cefixime demonstrates "extremely low penetration into fetal tissues and breast milk (<1% of the dose)" 4. While this study focused on pregnancy, the minimal transfer characteristics suggest limited infant exposure during lactation as well.
When using short-acting cephalosporins, choose drugs with short half-lives to minimize accumulation risk 5. Cefixime has favorable pharmacokinetics with once-daily dosing at 400 mg 4.
Infant Monitoring Requirements
If cefixime is used during breastfeeding:
- Monitor all breastfed infants for gastrointestinal effects due to alteration of intestinal flora 3
- Watch for mild diarrhea, gastroenteritis, or candidiasis 3
- Be aware that antibiotics in breast milk could potentially cause falsely negative cultures if the infant develops fever requiring evaluation 3
Clinical Decision Algorithm
First-line alternatives: Consider using cephalosporins with established lactation safety data (cephalexin, ceftriaxone) or amoxicillin/clavulanic acid, which are explicitly classified as "compatible" 2, 3
If cefixime is specifically indicated: The drug can be used based on class safety, but inform the mother about the lack of specific human data 1
Timing strategy: Administer medication immediately following a breast feed to minimize infant exposure during peak milk concentrations (typically 1-2 hours post-dose) 5
Short courses preferred: Use the shortest effective duration, as short courses of cephalosporins are commonly used without evidence of harmful effects 6
Important Caveats
- The safety profile assumes full-term, healthy infants and standard recommended doses 3
- Serious adverse events in breastfed infants from cephalosporin exposure are rare 7
- The benefits of continued breastfeeding should be weighed against the theoretical risks of minimal drug exposure 8
- Women should not be discouraged from breastfeeding while taking compatible medications given the substantial benefits 8