Cefuroxime Safety During Breastfeeding
Cefuroxime is compatible with breastfeeding and can be safely used in lactating women. 1
Guideline-Based Safety Classification
- The European Respiratory Society/Thoracic Society of Australia and New Zealand (ERS/TSANZ) explicitly classifies cefuroxime as "compatible" with breastfeeding, representing the highest safety designation for antibiotics during lactation 1
- This classification is supported by human data indicating that cefuroxime and other cephalosporins are not teratogenic at usual therapeutic doses 1
- Multiple international guidelines consistently recommend cephalosporins, including cefuroxime, as first-line safe options for breastfeeding mothers 2, 3, 4
FDA Drug Label Information
- The FDA drug label states that cefuroxime is excreted in human milk, and caution should be exercised when administered to nursing women 5
- However, this standard cautionary language does not contraindicate use, and clinical guidelines provide more specific safety assurance 1
Clinical Evidence Supporting Safety
- A prospective study of 38 breastfeeding women treated with cefuroxime found only 1 infant (2.6%) experienced adverse effects, which was not significantly different from controls (9%) 6
- All adverse effects observed were minor, self-limiting, and did not necessitate interruption of breastfeeding 6
- Cefuroxime concentrations measured in breast milk ranged from 0.09 to 0.59 μg/ml in healthy milk and 0.57 to 1.05 μg/ml in purulent milk, representing low levels of drug transfer 7
- Cephalosporins have limited oral bioavailability in infants, meaning even the small amounts present in breast milk are poorly absorbed by the nursing infant 2
Important Monitoring Considerations
- Monitor all breastfed infants for gastrointestinal effects (mild diarrhea, altered intestinal flora) when mothers receive any systemic antibiotic, though serious adverse events are rare 1, 2
- Be aware that antibiotics in breast milk could potentially cause falsely negative cultures if a febrile infant requires microbiological evaluation 1, 2
- These monitoring considerations apply to all antibiotics during lactation, not specifically to cefuroxime 1
Clinical Decision Algorithm
First-line choice: Cefuroxime and other cephalosporins (cephalexin, ceftriaxone) are explicitly compatible with breastfeeding and should be used preferentially 1, 2, 4
Equivalent alternatives: Penicillins such as amoxicillin are also classified as compatible and represent equally safe first-line options 1, 2, 3
When to avoid: There are no specific contraindications to cefuroxime use during breastfeeding in healthy term infants 1, 6
Common Pitfalls to Avoid
- Do not unnecessarily discontinue breastfeeding when cefuroxime is prescribed—the benefits of continued breastfeeding far outweigh the minimal theoretical risks of antibiotic exposure through breast milk 2
- Do not confuse pregnancy safety with lactation safety—while some antibiotics have different risk profiles in pregnancy versus lactation, cefuroxime is safe in both contexts 1
- Do not delay necessary antibiotic treatment due to unfounded concerns about breastfeeding safety when using compatible agents like cefuroxime 1, 6