From the Guidelines
For lactating women with bacterial conjunctivitis, topical antibiotics such as erythromycin ophthalmic ointment or polymyxin B-trimethoprim ophthalmic drops are the safest treatment options, as they have minimal systemic absorption and negligible transfer into breast milk 1.
Treatment Options
- Erythromycin ophthalmic ointment (0.5%) can be applied to the affected eye(s) 2-4 times daily for 7-10 days.
- Polymyxin B-trimethoprim ophthalmic drops can be used 1 drop every 3 hours (while awake) for 7-10 days.
Administration and Precautions
- When applying eye medication, gently wash hands before and after application, wipe away any discharge with clean, warm water, and apply ointment or drops to the lower eyelid pocket while avoiding direct contact between the medication applicator and the eye.
- It's essential to complete the full course of treatment even if symptoms improve quickly.
- These topical antibiotics work by disrupting bacterial cell walls or protein synthesis, effectively eliminating common conjunctivitis-causing bacteria like Staphylococcus aureus and Haemophilus influenzae without posing risks to the nursing infant.
Monitoring and Follow-up
- If symptoms worsen or don't improve within 48-72 hours, the patient should seek further medical evaluation.
- The choice of antibiotic should be based on local availability and susceptibility patterns, as recommended by the Working Group 1.
- Systemic antibiotics, such as azithromycin, may be considered in severe cases or when topical treatment is not effective, but their use should be cautious and based on the latest evidence 1.
From the FDA Drug Label
For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by Bacitracin susceptible organisms. For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by organisms susceptible to erythromycin.
The safest treatment for bacterial conjunctivitis in lactating women is erythromycin (OPHTH), as it is effective against a broader range of organisms and has an established use in infants, implying a safer profile for use during lactation.
- Bacitracin (OPHTH) may also be considered, but its use is more limited to Bacitracin susceptible organisms 2.
- Erythromycin (OPHTH) is a viable option for lactating women due to its effectiveness and safety profile 3.
From the Research
Treatment Options for Bacterial Conjunctivitis in Lactating Women
- Topical antibiotics are effective in treating bacterial conjunctivitis and can expedite recovery 4, 5, 6.
- The choice of antibiotic usually does not affect the outcome, but fluoroquinolones should be reserved for severe infections due to their broad spectrum of activity 6.
- Antibiotics such as gentamycin, tobramycin, and azithromycin are preferred for treating bacterial conjunctivitis 6.
- There is limited information on the safety of topical ophthalmic antibiotics in lactating women, but a study on pregnant women found no association between exposure to topical ophthalmic antibiotics and adverse neonatal outcomes 7.
Safety Considerations
- The safety of topical antibiotics in lactating women is not well-studied, but the risk of absorption into the bloodstream is generally considered low.
- A study on pregnant women found that topical ophthalmic antibiotics were not associated with increased adverse neonatal outcomes, but the results may not be directly applicable to lactating women 7.
- The benefits of treating bacterial conjunctivitis with topical antibiotics likely outweigh the risks, but lactating women should consult their healthcare provider before using any medication.