Antibiotics Safe for Breastfeeding

Safe First-Line Antibiotics for Breastfeeding Mothers

• The American Academy of Dermatology suggests that most β-lactam antibiotics, including penicillins and cephalosporins, are considered safe during breastfeeding and should be used as first-line options when appropriate for the infection 1, 2
• Amoxicillin and amoxicillin/clavulanic acid are explicitly recommended as safe options for breastfeeding mothers requiring antibiotic therapy 2
• Cephalosporins, like cephalexin, are generally considered safe during breastfeeding 3
• First-generation cephalosporins are particularly recommended for skin and soft tissue infections in breastfeeding women 3
• Cephalosporins have minimal transfer to breast milk and limited impact on the nursing infant 1

Other Safe Antibiotics

• The Journal of the American Academy of Dermatology suggests that metronidazole is safe for breastfeeding patients 4
• Rifampin can be used in breastfeeding patients with an approach similar to other patient populations 4

Antibiotics to Use with Caution or Avoid

• Clindamycin should be used with caution as it may increase the risk of GI side effects in the infant 4
• Tetracyclines, including doxycycline, should be limited to 3 weeks without repeating courses if no suitable alternative is available 1, 4

Clinical Decision-Making Algorithm

• Penicillins, such as amoxicillin, and cephalosporins, such as cephalexin, are considered first-line options for breastfeeding mothers 1, 2, 3
• Macrolides, including erythromycin and azithromycin, are suggested as safe options but should be avoided in the first 13 days postpartum if possible 4, 5

Important Considerations

• Continued breastfeeding during antibiotic treatment is generally recommended and does not pose significant risks to the infant 5
• The National Institutes of Health's LactMed database is a valuable resource for checking specific antibiotic safety during lactation 1

Safe Antibiotics for Breastfeeding Mothers

Antibiotics to Avoid

• Fluoroquinolones should not be used as first-line treatment during breastfeeding, as they may pose risks to the infant, according to the Rhinology guideline society 6
• Tetracyclines should be avoided beyond a 3-week limit, as they may impact infant development, as recommended by the Rhinology guideline society 6
• Aminoglycosides should not be used during breastfeeding due to potential risks to the infant, as advised by the Rhinology guideline society 6