Antibiotics and Breast Feeding

Most antibiotics are okay for mom to take while breastfeeding.  Good rule of thumb is if it is okay to give to baby, it is okay to give to mama!  My first question for every patient is “are these antibiotics really needed at this time?”  If you have to take antibiotics, it is best to limit use of quinolones (such as ciprofloxaxin, levofloxacin) because we try to not use these in kids due to concern for joint damage seen in animal studies.  Also good to limit use of tetracyclines because link to staining teeth in children.  If these medications MUST be used, the good thing is that the calcium in breastmilk will bind quinolone and tetracycline and limit the amount actually passed to baby.

Another antibiotic that many ask about is metronidazole (Flagyl).   Typically dose is 500mg every 12 hours.   It is considered okay in breast feeding because the amount found in breastmilk is usually less then would be given to baby.  However, sometimes the dose is high -2g x1 dose.  If you need to take this high dose, it might be best to pump and dump for 12-24 hours following the dose.

It is best to avoid trimethoprim-sulfamethoxazole (Bactrim, Co-Trimoxazole) while breastfeeding because it can increase bilirubin in babies.  Also avoid nitrofurantoin due to risk of hemolytic anemia (red blood cells are destroyed).

If you are taking an antibiotic, watch your baby for any reaction/side effects she could be experiencing, such as diarrhea, skin rash, diaper rash or thrush.

Always make sure that your healthcare practitioner and pharmacist know that you are breastfeeding!

What experiences have you had nursing and taking antibiotics?  Any tips?

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