Cefuroxime for Lactation Mastitis
Cefuroxime axetil is a reasonable and safe treatment option for lactation mastitis in breastfeeding women, with demonstrated clinical efficacy and compatibility with breastfeeding. 1
Evidence Supporting Use During Lactation
β-Lactam antibiotics, including cefuroxime, are commonly used and overall thought to be safe during lactation. 1 The 2020 European Respiratory Society/Thoracic Society of Australia and New Zealand guidelines explicitly classify cefuroxime (B1) as "Compatible" with breastfeeding, noting that human data indicate cefuroxime and other cephalosporins are not teratogenic at usual therapeutic doses. 1
Key Safety Considerations:
Cefuroxime is excreted in breast milk but at low concentrations. 2 A clinical study measuring cefuroxime levels in breast milk after 500 mg oral administration found concentrations ranging from 0.09 to 0.59 μg/mL (mean: 0.32 μg/mL) in healthy milk at 30-90 minutes post-dose. 3
The FDA label advises caution when administering cefuroxime to nursing women, but does not contraindicate its use. 2 This reflects the general principle that most systemic antibiotics will be present in breast milk and could theoretically cause altered intestinal flora in the infant. 1
Clinical Efficacy for Mastitis
Cefuroxime axetil has demonstrated good clinical efficacy specifically for acute mastitis in lactating women. 3 In a Japanese study of 10 lactating outpatients with acute mastitis treated with cefuroxime axetil 500 mg three times daily for 5-8 days:
- Clinical response was excellent in 2 cases and good in 8 cases (100% success rate) 3
- No adverse effects were observed 3
- All isolated organisms (5 Staphylococcus aureus and 2 S. epidermidis strains) had MICs ≤3.13 μg/mL 3
Recommended Dosing Regimen
For lactation mastitis, cefuroxime axetil 500 mg twice daily is the standard adult dose. 4 For more severe infections, 500 mg every 8 hours may be considered. 4 Treatment duration should be 7-10 days for skin and soft tissue infections, which is the appropriate category for mastitis. 4
Comparison to Alternative Antibiotics
While specific guidelines for lactation mastitis treatment are limited in the provided evidence, cefuroxime offers several advantages:
- Broader spectrum than first-generation cephalosporins (which are ineffective for many infections and should not be used). 1
- Better stability to β-lactamases than amoxicillin alone, providing coverage against β-lactamase-producing Staphylococcus aureus strains commonly implicated in mastitis. 3
- Safer than fluoroquinolones and tetracyclines during lactation, which are generally avoided due to potential developmental impacts on the infant. 1
Important Clinical Pitfalls
- Do not use first-generation cephalosporins (cephalexin, cefadroxil) for mastitis, as they have inadequate activity against common pathogens. 1
- Assess for penicillin/cephalosporin hypersensitivity before initiating therapy. 4
- Monitor for antibiotic-associated diarrhea in both mother and infant, as this is a common problem with antibiotics. 2
- Consider bacterial culture if symptoms do not improve within 48-72 hours to guide targeted therapy. 5