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Conselling a breast feeding mom with serious sinus infection allergic to penicillin. Baby 4 mo; ~14#. What antibiotic is safe?
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Dear Lesley,
There are few antibiotics that are contraindicated during breastfeeding. Tetracyclines have been known for their teeth staining and adverse bone effects in children thus are not used in pediatrics. However, doxycycline is the least teeth staining of the tetracycline class, and Dr. Hale suggests use for up to three weeks is acceptable during breastfeeding. Sulfa medications such as Macrobid and Bactrim should not be used in the first month of life as if the breastfed infant is jaundiced or has undiagnosed G6PD deficiency, these medications may cause untoward effects such as kernicterus. According to UpToDate, chronic sinusitis may be treated with clindamycin or a combination of two antibiotics such as metronidazole plus cefuroxime, cefdinir, azithromycin, clarithromycin or trimetoprim-sulfamethoxazole. For acute sinusitis in penicillin allergic patients, doxycycline or azithromycin may be used. Levofloxacin is also another choice. The relative infant dose is slightly high (10.5% to 17.2%) but this medication is only taken once daily and has a short half-life of six to eight hours so if the child sleeps an extended period at night, the mother could breastfeed before bedtime then take her dose. So depending on whether her physician considers her condition acute or chronic, the above medications for acute and chronic sinusitis are choices compatible with breastfeeding. As with any antibiotic during breastfeeding, the infant should be observed for diarrhea or other untoward reactions.
Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center
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