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Antibiotics are medications to treat bacterial infections. Taking antibiotics while breastfeeding may not be wise without consulting a doctor. Medications may reach the baby via breastmilk and cause harmful side effects in them. This holds true for antibiotics as well. Antibiotics may be of several types, and only a healthcare professional can help you identify the one suitable during breastfeeding after assessing your condition. Additionally, indiscriminate use of antibiotics results in the development of bacterial resistance, and the medications may cease to be effective. This post talks about the use of antibiotics in nursing mothers and provides a list of those considered safe.
Is It Safe To Take Antibiotics While Breastfeeding?
The safety of antibiotics depends on the type and quantity of the drug. The majority of antibiotic drugs are safe to consume during lactation and do not have any adverse effects on the baby’s health (1).
Will All The Antibiotics Pass Into Your Breastmilk?
Yes, all medicines, including antibiotics, have the potential to pass into breastmilk since the breast receives nutrients from the blood. The quantity of antibiotic passed primarily depends on the frequency of the dosage and concentration of the antibiotic compounds. There is no scientific evidence to suggest that antibiotics reduce the milk supply.
However, you must consult your doctor about it before you consume any antibiotics because numerous factors determine the transfer of the drug compounds to the baby.
Factors That Determine The Effects Of Antibiotics On Babies
Each drug can affect a baby differently, while the active compounds in the drugs play a major role. Here are some key determinants:
1. Baby’s age and general health
The adverse effects of antibiotics are acutely noticed in babies younger than two months and rarely among those older than six months (2). Therefore, age plays a significant role in determining the effects. The baby’s kidney and liver are still developing and are not adept at flushing out the additional antibiotic compounds (3).
Other infant-related factors are the baby’s overall health and medical conditions or anomalies such as gastrointestinal reflux, shorter digestive tract, and allergic sensitivity to different compounds.
2. Breast milk composition and acidity
Some antibiotic molecules have a natural tendency to dissolve in milk that has greater protein content than blood. The situation gets compounded in women with premature babies, as they produce milk with higher protein levels than those who have a full-term baby. Thus, mothers of premature babies need to be extra cautious about antibiotic consumption.
Antibiotics with basic compounds bind with acidic milk molecules. The acidity of breastmilk increases as the infant grows older, but the ability of the baby’s body to process antibiotic compounds also improves.
3. Active compounds in drugs
Certain antibiotic compounds such as erythromycin, lincomycin, and metronidazole have a higher tendency to bind with milk proteins than compounds such as sulphonamide and penicillin. Some compounds have greater ionization potential than others, making them more inclined to transfer from bloodstream to breastmilk. The breast tissue can metabolize some antibiotic compounds, such as sulphonamide, by breaking them down into harmless molecules that pose no risk to the baby.
Some antibiotics employ the use of radioactive substances and are referred to as radiopharmaceuticals. These compounds can have an adverse effect on the health of the baby. Lactating mothers are asked to cease breastfeeding temporarily when they are receiving a dose of radioactive antibiotics.
Some antiviral-antibiotic compounds have poor absorption rate through the oral-digestive route in babies, making them safe for consumption by a lactating mother.
4. Antibiotics in combination with other drugs
The safety of an antibiotic also depends on the combination of other drugs prescribed by the doctor. It means a safe antibiotic when consumed in conjunction with other drugs may form compounds that could harm the baby (4). For example, the antibiotic erythromycin can have a cross-reaction with other drugs such as cyclosporin, carbimazole, digoxin, theophylline, triazolam, and some anticoagulants.
5. Chemical characteristics of the antibiotic
Chemical factors such as half-life, molecular weight, and lipid solubility of an antibiotic compound can determine its ability to persist in breastmilk. Longer half-life means that the antibiotic will take substantial time to breakdown. The same applies for a compound with heavier molecular weight. If an antibiotic binds to fat/lipid quickly, then it will transfuse faster from blood to milk. The concentration of the antibiotic compound in the mother’s blood determines its level in breastmilk (5). So a 20mg of a drug is going to last longer than 5mg of the same drug.
Antibiotic compounds are complex anti-bacterial molecules, whose effects can be subjective. However, it is good to learn about antibiotics that are safe or unsafe for consumption during lactation.
Safe Medicines In Lactation
The following is a list of antibiotics that are proven to be safe/ unsafe for a lactating mother and her baby (6). Remember to consult a doctor before consuming any antibiotics:
Antibacterial
| Safe | Effects unknown; consume with caution | Unsafe |
|---|---|---|
| Aminoglycosides | Chloramphenicol | Metronidazole (single high dose) |
| Amoxycillin | Clindamycin | Quinolones |
| Amoxycillin-clavulanate | Dapsone | |
| Antitubercular drugs | Mandelic acid | |
| Cephalosporins | Metronidazole (low dose) | |
| Macrolides | Nalidixic acid | |
| Trimethoprim-sulphamethoxazole | Nitrofurantoin | |
| Penicillins | ||
| Tetracyclines |
Antiviral
| Safe | Effects unknown; consume with caution |
|---|---|
| Acyclovir | Antiretrovirals |
| Amantadine | Famciclovir |
| Valacyclovir | Foscarnet |
| Ganciclovir |
Antifungal
| Safe | Effects unknown; consume with caution |
|---|---|
| Ketoconazole | Amphotericin |
| Fluconazole | |
| Flucytosine | |
| Itraconazole |
Antimalarial
| Safe | Effects unknown; consume with caution |
|---|---|
| Chloroquine | Mefloquine |
| Hydroxychloroquine | Pentamidine |
| Quinine | Proguanil |
| Primaquine | |
| Pyrimethamine |
Antihelminthic
| Effects unknown; consume with caution |
|---|
| Mebendazole |
| Pyrantel pamoate |
| Praziquantel |
| Quinacrine antihelminth |
| Thiabendazole |
| Piperazine |
Are There Any Adverse Effects Of Antibiotics?
An infant may suffer adverse health effects if the mother consumes a non-recommended antibiotic during lactation. An overdose of a safe antibiotic can also lead to the following conditions in the baby:
1. Modified gut flora
Antibiotics don’t just affect the targeted disease-causing bacteria but also influence the constitution and density of natural bacterial flora found in small intestines. Babies, in particular, have underdeveloped colonies of ‘good bacteria’ that help in digestion. The ingestion of antibiotic through breastmilk can damage the existing bacterial colonies in the gut, leading to malabsorption of food nutrients, causing diarrhea.
2. Neonatal sepsis
Sepsis occurs
when the immune system has an over-reaction to a pathogen, ultimately damaging the healthy tissue of the body. Babies have a weak immune system that is not adept at recognizing foreign pathogen nor can amplify the favorable effects of an antibiotic. An antibiotic can genetically modify the natural bacterial fauna of the body, which may confuse the undeveloped immune system leading to an aggressive reaction causing sepsis.
If you suspect that your baby is showing signs of a problem due to your antibiotic consumption, then take him to a doctor immediately.
Points To Discuss With The Doctor
If you are a lactating mother, then inform the doctor about the same, so that he considers this while prescribing antibiotics. Here are some points that you must discuss:
- You are a lactating mother. This is the first thing that you must inform him before the doctor writes down the prescription.
- If you are on some other medication. An antibiotic may react with other medicines and form compounds that may be harmless for the mother but not the baby.
- Your baby’s age and general health. It is essential to share the baby’s age and medical condition, if any.
- Alternatives to medication. If your medical condition is not severe, your doctor can suggest some precautionary steps to treat it. That way, you can avoid consuming antibiotics.
Since antibiotics have their risks, look for ways in which you can circumvent the effects.
Avoiding The Risks Of Antibiotics In Babies
You can keep your baby away from the dangers of antibiotics by taking certain measures:
- Choose topical treatment over oral medication: Choose antibiotic ointments and creams instead of their oral derivative. It helps localize the usage of the antibiotic, and thus prevent its transfer into the breastmilk.
- Select antibiotics that are safe for infants: If an antibiotic is safe for babies, then it is certainly safe for a lactating mother. You can discuss the availability of such medicines with your doctor.
- Have a single dose right after you breastfeed: Take the antibiotic immediately after you feed your baby, so that the gap between the consumption and the next feeding session is the maximum. It could be any time of the day. You can decide the time and dosage depending on the baby’s feeding habits.
- Use antibiotics with poor oral bioavailability in infants: Some antibiotics are not absorbed by the baby’s digestive tract and pass out without causing any harm. These drugs are safe to consume even if there are residual traces of it in the breastmilk.
Remember:
Never self-medicate even for the mildest medical condition since you do not know whether the medicine is safe for the baby. Buying through a doctor’s prescription and observing discretion are the best ways to keep your baby safe when you have antibiotics during the lactation phase.
While lactating mothers may safely consume most antibiotics, some antibiotics can have several adverse effects on the nursing infant since they may pass to the baby via breastmilk. Hence, consume antibiotics while breastfeeding only under the doctor’s guidance since they will adequately weigh the benefits and risks before prescribing any antibiotic for the nursing mother. Further, take your antibiotics dose soon after a breastfeeding session and choose topical antibiotics over oral ones when possible to limit the risk of transfer through breastmilk.
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