Antibiotic Use During Breastfeeding

Safety Concerns with Fluoroquinolones

Fluoroquinolones have been associated with cartilage damage in animal studies, raising theoretical concerns about effects on developing infants, and are typically not recommended as first-line treatment during lactation 1
If fluoroquinolones are clinically indicated, ciprofloxacin is the preferred agent within this class due to more extensive safety data 1

The European Respiratory Journal suggests that several antibiotic classes are considered compatible with breastfeeding and should be used preferentially, including penicillins, cephalosporins, and macrolides 2, 3
Penicillins, such as amoxicillin, and cephalosporins, such as cefuroxime, are considered compatible with breastfeeding 3
Macrolides, such as azithromycin, are considered probably safe, though there is a very low risk of hypertrophic pyloric stenosis if used during the first 13 days of breastfeeding 3

Most systemic antibiotics will be present in breast milk and could potentially cause falsely negative cultures in febrile infants or produce gastroenteritis due to alteration of intestinal flora 3

First-line options for breastfeeding mothers include penicillins, such as amoxicillin, and cephalosporins, such as cefuroxime 3
Second-line options include macrolides, such as azithromycin, if not within the first 13 days of breastfeeding 3
Third-line options include ciprofloxacin, a fluoroquinolone, if benefits clearly outweigh risks 1

Sefalosporin, termasuk cefadroxil, dianggap kompatibel dengan menyusui menurut pedoman European Respiratory Journal 4, 5

Absorpsi oral sefalosporin pada bayi minimal karena bioavailabilitas oral yang rendah 4
Perhatikan kemungkinan perubahan flora usus yang dapat menyebabkan diare ringan, meskipun jarang terjadi 5

Cefadroxil dan sefalosporin lain (cefuroxime, cephalexin) adalah pilihan yang aman dan kompatibel 4, 5

The American Academy of Pediatrics recommends continuing breastfeeding or milk expression during mastitis treatment, as this is essential for resolution and prevents complications 6, 7
Continued breastfeeding is crucial for mastitis resolution, with approximately 10% of mastitis cases progressing to breast abscess if not properly treated, and regular milk removal is a key component of therapy 6
Breastfeeding should continue even on the affected breast, as long as the infant's mouth does not contact purulent drainage if an abscess has developed 6, 7

The benefits of continued breastfeeding far outweigh the minimal theoretical risks of cephalexin exposure through breast milk, and premature cessation of breastfeeding due to unnecessary concerns about antibiotics causes more harm, including risks of breast engorgement, blocked ducts, formula intolerance, and loss of breastfeeding's protective benefits 8