What are the appropriate oral antibiotics (abx) for the treatment of paronychia in a breastfeeding mother?

From the Guidelines

For paronychia in breastfeeding women, oral azithromycin is suggested as a safe option, as indicated by the most recent guidelines 1. When considering oral antibiotics for paronychia in breastfeeding patients, it's essential to prioritize the safety of both the mother and the infant.

• The primary concern is to minimize the risk of morbidity, mortality, and impact on quality of life for both.
• Given the available evidence, oral azithromycin is recommended due to its safety profile during breastfeeding, as suggested by the North American clinical practice guidelines for the medical management of hidradenitis suppurativa in special patient populations 1.
• Other options like oral erythromycin 1, amoxicillin/clavulanic acid 1, and metronidazole 1 may also be considered, but azithromycin is the most recently suggested option.
• It's also important to note that caution should be exercised when using oral clindamycin due to the potential risk of GI side effects in the infant 1.
• Treatment should be started promptly to prevent progression of the infection, and patients should be advised on proper wound care and follow-up.

From the FDA Drug Label

Nursing Mothers Limited published data based on breast milk sampling reports that clindamycin appears in human breast milk in the range of less than 0.5 to 3. 8 mcg/mL. Clindamycin has the potential to cause adverse effects on the breast-fed infant's gastrointestinal flora. If oral or intravenous clindamycin is required by a nursing mother, it is not a reason to discontinue breastfeeding, but an alternate drug may be preferred Monitor the breast-fed infant for possible adverse effects on the gastrointestinal flora, such as diarrhea, candidiasis (thrush, diaper rash) or rarely, blood in the stool indicating possible antibiotic-associated colitis

• Clindamycin can be used in breastfeeding mothers, but it is recommended to monitor the infant for adverse effects on the gastrointestinal flora, such as diarrhea or candidiasis 2.
• It is not necessary to discontinue breastfeeding, but an alternate drug may be preferred.
• The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for clindamycin.

From the Research

Oral Antibiotics for Paronychia and Breastfeeding

• The use of oral antibiotics for paronychia in breastfeeding mothers requires careful consideration of the potential risks and benefits to both the mother and the infant 3.
• Paronychia is an inflammation of the folds of tissue surrounding the nail, and acute paronychia is mainly due to bacterial infection, such as Staphylococcus aureus or Streptococcus 4.
• The treatment of paronychia with oral antibiotics is not always necessary, and systemic antibiotics are ineffective unless infection is proven 4.
• However, in cases where antibiotic treatment is necessary, most antibiotics in clinical use are considered suitable during breastfeeding, but the pharmacokinetic profile of each drug must be observed to ensure the resolution of the maternal infection and the safety of the infant 3.
• For example, amoxicillin has been shown to be effective in treating group A Streptococcal paronychia in children, with favorable outcomes in all cases without any surgical procedures 5.
• It is essential to note that the decision to use oral antibiotics for paronychia in breastfeeding mothers should be made on a case-by-case basis, taking into account the severity of the infection, the potential risks and benefits of treatment, and the pharmacokinetic profile of the antibiotic being used 3.