Is cefuroxime safe for use in a lactating mother, and what dosage and precautions are needed for premature, low‑birth‑weight, or renally impaired infants?

Cefuroxime Safety During Breastfeeding

Yes, cefuroxime is compatible with breastfeeding and can be safely administered to lactating mothers. 1, 2, 3

Safety Classification and Evidence

Cefuroxime is explicitly classified as "compatible" with breastfeeding by the European Respiratory Society/Thoracic Society of Australia and New Zealand (ERS/TSANZ) guidelines, representing the highest safety designation for antibiotics during lactation. 1, 2, 3

• Human data confirm that cefuroxime and other cephalosporins are not teratogenic at usual therapeutic doses and are safe for use in nursing mothers 1
• The FDA drug label states that cefuroxime is excreted in human milk, but caution should be exercised when administered to nursing women 4
• A prospective study of 38 women treated with cefuroxime during lactation found only 2.6% of infants experienced adverse effects, which was not significantly different from controls (9%), and all effects were minor and self-limiting 5

Dosing and Administration

• Standard adult dosing should be used as recommended for the specific indication 4
• Administer the medication immediately following a breastfeed to minimize infant exposure during peak milk drug concentrations, which typically occur 1-2 hours after oral administration 6
• Choose short-acting cephalosporins when possible to minimize accumulation risk 6

Infant Monitoring Considerations

All breastfed infants whose mothers are taking cefuroxime should be monitored for gastrointestinal effects, though serious adverse events are rare. 1, 2, 7

• Watch for mild diarrhea or gastroenteritis due to alteration of intestinal flora 1, 2
• Monitor for any uncharacteristic symptoms, particularly in younger infants 6
• Be aware that antibiotics in breast milk could potentially cause falsely negative cultures if the infant develops fever requiring evaluation 1, 2

Special Populations Requiring Extra Caution

Exercise additional caution when treating mothers of premature infants, low-birth-weight infants, or those with renal impairment. 4, 6

• Accumulation of cephalosporins in newborn infants with resulting prolongation of drug half-life has been reported 4
• Safety and effectiveness in pediatric patients below 3 months of age have not been fully established 4
• The infant's metabolic and excretory capacities rapidly improve during the first months of life, so risk of toxicity decreases with increasing infant age 6
• For infants with renal impairment, closer monitoring is warranted as cefuroxime is substantially excreted by the kidney 4

Clinical Decision Algorithm

First-line approach:

• Cefuroxime and other cephalosporins (cephalexin, ceftriaxone) are safe and compatible choices for breastfeeding mothers 1, 2, 3
• Penicillins such as amoxicillin are equally safe alternatives if appropriate for the indication 2, 3, 7

Alternative options if cephalosporins are contraindicated:

• Macrolides such as azithromycin are "probably safe," though avoid during the first 13 days postpartum due to very low risk of hypertrophic pyloric stenosis 1, 2, 3

Common Pitfalls to Avoid

Do not unnecessarily discontinue breastfeeding when cefuroxime is prescribed. 5, 7

• The benefits of continued breastfeeding far outweigh the minimal theoretical risks of cefuroxime exposure through breast milk 7
• Breastfeeding should not be interrupted for cefuroxime therapy, as the drug is fully compatible with lactation 1, 2, 3
• Do not recommend "pump and dump" strategies, as this is not evidence-based for cefuroxime use 7
• Avoid prescribing longer-acting cephalosporins when shorter-acting alternatives like cefuroxime are appropriate, to minimize accumulation risk 6