Antibiotics to Avoid During Pregnancy and Breastfeeding

Pregnancy: Antibiotics to Avoid

Aminoglycosides, such as gentamicin and tobramycin, are associated with eighth cranial nerve damage and theoretical nephrotoxicity in the fetus, according to the European Respiratory Journal 1
Trimethoprim should be avoided, especially during the first trimester, and only used for short courses if absolutely necessary, as recommended by the European Respiratory Journal 1
Fluconazole doses of 400 mg/day or more during the first trimester are associated with craniosynostosis and dysmorphic facies, and doses over 150 mg/day are linked to miscarriage, as reported by the European Respiratory Journal 1
Sulfonamides and cotrimoxazole should be used as second-line agents only and avoided in the first trimester, according to the European Respiratory Journal 1
Vancomycin has limited experience in the first trimester and should only be used for life-threatening infections, as stated by the European Respiratory Journal 1

Fluoroquinolones should not be used as first-line treatment during breastfeeding due to theoretical cartilage damage concerns from animal studies, though ciprofloxacin is the preferred agent if this class is clinically necessary, as recommended by Praxis Medical Insights 2
Aminoglycosides, such as tobramycin and gentamicin, should be avoided during breastfeeding for 2 hours following IV injection, and renal function and auditory testing should be monitored if treatment is prolonged, as advised by the European Respiratory Journal 1
Oral clindamycin may increase the risk of gastrointestinal side effects in the infant, according to Praxis Medical Insights 3
Doxycycline should be limited to a maximum of 3 weeks without repeating courses and only used if no suitable alternative is available, as recommended by Praxis Medical Insights 3
Macrolides, such as azithromycin and erythromycin, have a very low risk of hypertrophic pyloric stenosis if used during the first 13 days of breastfeeding and are safe after 2 weeks, as reported by Praxis Medical Insights 2 and 3

Penicillins, such as amoxicillin and ampicillin, are compatible with breastfeeding and considered low risk, according to the European Respiratory Journal and Praxis Medical Insights 1 and 2
Cephalosporins, such as cefuroxime, ceftriaxone, and cefadroxil, are compatible with breastfeeding and have low oral bioavailability in infants, as stated by the European Respiratory Journal and Praxis Medical Insights 1 and 2
Amoxicillin/clavulanic acid is a safe and effective choice, with an FDA Category B rating, as recommended by Praxis Medical Insights 3
Metronidazole is considered safe during breastfeeding, according to Praxis Medical Insights 3

All breastfed infants should be monitored for gastrointestinal effects, such as diarrhea and altered flora, when the mother receives antibiotics, as advised by Praxis Medical Insights 2 and 3
Antibiotics in breast milk may cause falsely negative cultures if a febrile infant requires evaluation, as reported by Praxis Medical Insights 2