Use of Antibiotic and Analgesic Drugs during Lactation

Abstract

During lactation, multiple situations can arise that require maternal pharmacological treatment. Because of the many health advantages of human milk to infants, breast feeding should be interrupted only when the needed drug might be harmful to the nursing child and exposure via the breast milk will be sufficient to pose a risk. Since the majority of drugs have not been shown to cause adverse effects when used during lactation, and even temporary interruption of breast feeding can be difficult for the nursing dyad, decisions regarding maternal medication use during breast feeding should be based on accurate and up-to-date information. This article reviews available data on the most commonly used antibiotics and analgesics. The use of most antibiotics is considered compatible with breast feeding. Penicillins, aminopenicillins, clavulanic acid, cephalosporins, macrolides and metronidazole at dosages at the low end of the recommended dosage range are considered appropriate for use for lactating women. Fluoroquinolones should not be administered as first-line treatment, but if they are indicated, breast feeding should not be interrupted because the risk of adverse effects is low and the risks are justified. Paracetamol (acetaminophen), low-dose aspirin (acetylsalicylic acid) [up to 100 mg/day] and short-term treatment with NSAIDs, codeine, morphine and propoxyphene are considered compatible with breast feeding. Safer alternatives should be considered instead of dipyrone, aspirin at a dosage >100 mg/day and pethidine (meperidine). In the light of the many safe alternatives for pain control, breast-feeding mothers should not be allowed to experience pain or be made to feel that they must choose between analgesia and breast feeding.

VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy

“…109,110 Theoretically, nursing infants of mothers taking aspirin could be at risk for developing Reye syndrome. 107 The use of lowdose aspirin ( , 100 mg/d) late in pregnancy was not associated with signifi cant effects on neonatal platelet function. 111,112 In a prospective study of 15 breastfeeding mothers taking aspirin therapy, no negative effects were noted (Tables S4, S5).…”

“…107 There are, therefore, potential risks of platelet dysfunction and GI bleeding in nursing infants of mothers using high doses of this drug. 107,108 Metabolic acidosis has been reported in breast-fed infants of mothers taking several grams of aspirin per day. 109,110 Theoretically, nursing infants of mothers taking aspirin could be at risk for developing Reye syndrome.…”

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

“…The principles of passage of drugs in human milk (Ito, 2000;Berlin & Briggs, 2005;Ilett & Kristensen, 2005) including drugs relevant to pain management (Rathmell et al, 1997;Spigset & Hagg, 2000;Bar-Oz et al, 2003) have been reviewed. The maternal plasma concentration, which is influenced by the dose and the ability of the mother to metabolise the drug, is an important determinant of drug levels in milk.…”

“…Despite similar proportional transfer as paracetamol, salicylates are eliminated slowly by the neonate, cause platelet dysfunction and have been associated with Reye's syndrome; aspirin in analgesic doses cannot be recommended as safe (Bar-Oz et al, 2003).…”

Gravidez, Aleitamento e Fármacos em Dermatologia - Tratamento Sistémico

“…17 Apesar de a experiência com a utilização da azitromicina e claritromicina durante a amamentação ser mais escassa em relação à utilização da eritromicina, não foram até agora detetados quaisquer efeitos adversos para o lactente com a utilização destes dois macrólidos. 48,51 A clindamicina não tem mostrado aumentar o risco de malformações congénitas durante o primeiro trimestre (categoria de risco B pela FDA). 7 Pelo risco de colite pseudomembranosa é de segunda linha em relação aos antibióticos beta-lactâmicos.…”