What is the approach and treatment for a breastfeeding lady with fever and upper respiratory tract infection?

Management of Upper Respiratory Tract Infection in a Breastfeeding Mother

Primary Recommendation

Continue breastfeeding without interruption and treat symptomatically with acetaminophen or ibuprofen; antibiotics are not indicated for viral upper respiratory tract infections. 1, 2, 3

Breastfeeding Management

Do not discontinue breastfeeding during maternal upper respiratory tract infection. 1, 4, 2

• Breast milk provides protective antibodies and immune factors that actively protect the infant against respiratory infections, including immunoglobulin A and interferon-α. 1, 4, 2
• There is no evidence of viral transmission through breast milk. 4, 2
• Infants who are not breastfed have almost a threefold greater risk of hospitalization for lower respiratory tract disease compared to those exclusively breastfed. 1, 4

Infection Control During Breastfeeding

• Practice strict hand hygiene before every feeding to minimize transmission through respiratory secretions or direct contact. 4, 2
• Wear a surgical mask during breastfeeding if actively symptomatic with cough or sneezing to reduce respiratory droplet transmission. 4, 2
• If the mother is too severely ill to breastfeed directly, expressed breast milk should be given to the infant. 4, 2

Symptomatic Treatment

Analgesics and Antipyretics (Safe During Breastfeeding)

• Acetaminophen (paracetamol) is compatible with breastfeeding and appropriate for fever and pain control. 5, 6
• Ibuprofen and other NSAIDs at standard doses are considered compatible with breastfeeding for short-term treatment. 6
• Low-dose aspirin (up to 100 mg/day) is compatible, but higher doses should be avoided. 6

Decongestants and Antihistamines

• Over-the-counter decongestants and antihistamines may be used to treat congestion and runny nose, though specific safety data during lactation should be verified. 7

Antibiotic Use: When NOT Indicated

Antibiotics should NOT be prescribed for uncomplicated viral upper respiratory tract infections in breastfeeding mothers. 3, 8

• Most acute upper respiratory tract infections are viral and do not benefit from antibiotics. 3, 8
• Antibiotics are not indicated for the common cold, influenza, COVID-19, or laryngitis. 3
• Inappropriate antibiotic use contributes to adverse events, antibiotic resistance, and unnecessary costs. 3

Antibiotic Use: When Indicated

If bacterial infection is suspected or confirmed (e.g., group A streptococcal pharyngitis, acute bacterial sinusitis, acute otitis media), antibiotics are compatible with breastfeeding: 6, 3

• Penicillins, aminopenicillins (amoxicillin), cephalosporins, and macrolides are considered appropriate for lactating women. 1, 6
• Amoxicillin is the reference treatment for bacterial respiratory infections during lactation. 1, 6
• Azithromycin and clarithromycin are compatible, though there is a very low risk of hypertrophic pyloric stenosis in infants exposed during the first 13 days of breastfeeding. 1
• Fluoroquinolones should not be first-line but do not require breastfeeding interruption if indicated, as the risk of adverse effects is low. 1, 6

Special Consideration: Influenza

If influenza is confirmed or suspected: 2, 9

• Oseltamivir 75 mg twice daily for 5 days is the preferred antiviral and does not contraindicate breastfeeding. 2, 9
• Treatment should be initiated within 48 hours of symptom onset for maximum benefit. 9
• Continue direct breastfeeding with hand hygiene and mask use. 2, 9

Common Pitfalls to Avoid

• Never advise stopping breastfeeding due to maternal upper respiratory infection—this leads to unnecessary formula supplementation and loss of protective benefits. 1, 4, 2
• Do not prescribe antibiotics for viral upper respiratory infections—this is the most common inappropriate use of antibiotics in primary care. 3
• Do not delay symptomatic treatment with acetaminophen or ibuprofen due to concerns about breastfeeding—these are explicitly safe. 5, 6