From the FDA Drug Label
In streptococcal infections, therapy must be sufficient to eliminate the organism (ten-day minimum): otherwise the sequelae of streptococcal disease may occur. NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever.
Strep throat infection treatment in breastfeeding:
- The provided drug labels do not directly address the treatment of strep throat infection in breastfeeding women.
- However, penicillin is mentioned as the usual drug of choice for the treatment of Streptococcus pyogenes infection.
- Azithromycin is mentioned as an alternative to first-line therapy in individuals who cannot use first-line therapy for pharyngitis/tonsillitis caused by Streptococcus pyogenes.
- No information is provided on the safety of these medications during breastfeeding, therefore, a conservative clinical decision would be to consult the FDA drug label for each medication or other reliable sources for guidance on their use during breastfeeding 1 2.
From the Research
Breastfeeding mothers with strep throat infection can be safely treated with penicillin or amoxicillin, which are considered compatible with breastfeeding. The first-line treatment is penicillin, typically prescribed as penicillin V 500 mg orally twice daily for 10 days, or amoxicillin 500 mg three times daily for 10 days 3. For those with penicillin allergies, alternatives include cephalexin 500 mg four times daily for 10 days or, in cases of severe penicillin allergy, azithromycin 500 mg on day one followed by 250 mg daily for four more days. However, it's essential to note that there is significant resistance to azithromycin and clarithromycin in some parts of the United States 3.
Some key points to consider when treating strep throat infection in breastfeeding mothers include:
- Completing the full course of antibiotics even if symptoms improve quickly to prevent complications like rheumatic fever
- Continuing breastfeeding as normal, as minimal amounts of the antibiotics pass into breast milk
- Staying hydrated, using over-the-counter pain relievers like acetaminophen or ibuprofen for discomfort, and gargling with warm salt water for throat pain
- Being aware that breastfeeding can actually help protect the baby from infection through the antibodies in the mother's milk, and treating the infection promptly prevents transmission to the baby through close contact
It's also important to note that guidelines recommend using clinical decision rules to assess the risk of group A beta-hemolytic streptococcal infection, followed by rapid antigen testing if a diagnosis is unclear, before prescribing antibiotics 3. Fever, tonsillar exudate, cervical lymphadenitis, and patient ages of 3 to 15 years increase clinical suspicion, while a cough is more suggestive of a viral etiology.
Overall, the treatment of strep throat infection in breastfeeding mothers should prioritize the use of antibiotics that are safe and effective, while also considering the potential risks and benefits of different treatment options. The most recent and highest quality study recommends penicillin or amoxicillin as the first-line treatment 3.