Breastfeeding and Antibiotic Use

Safety of Antibiotics During Breastfeeding

• Amoxicillin-clavulanate is safe to use during breastfeeding, though monitoring the infant for potential gastrointestinal effects is recommended, as stated by the American Academy of Dermatology and classified as "compatible" with breastfeeding by the European Respiratory Society 1, 2
• The following antibiotics are generally safe during breastfeeding:

• Tetracycline and fluoroquinolones are generally not recommended during breastfeeding due to potential effects on infant development, while methotrexate should not be used during breastfeeding due to accumulation in newborn tissues, as noted by the Gastroenterology journal and Arthritis care & research journal 3, 4, 5
• Biologics, such as those used for hidradenitis suppurativa, are likely safe during breastfeeding, with minimal medication passing into breast milk, as noted by the American Academy of Dermatology, and adalimumab is strongly recommended for mothers with hidradenitis suppurativa if biologics are required during breastfeeding 1
• Metformin is suggested as a safe option for anti-androgens during breastfeeding, and prednisone ≤20 mg daily is suggested for immunomodulators, with higher doses requiring a 4-hour wait before breastfeeding, as recommended by the American Academy of Dermatology 1

Diagnosis and Treatment of Breast Infections

• Breast infection is typically diagnosed clinically, based on symptoms such as focal breast tenderness, fever, and fatigue, and treatment should be initiated promptly with amoxicillin-clavulanate as the first choice for 7-10 days, or cephalosporins or clindamycin in cases of penicillin allergy, as recommended by the American Academy of Pediatrics and the American Academy of Dermatology 3, 6
• Infants should be monitored for potential side effects of antibiotic treatment, such as diarrhea, rash, allergic reactions, unusual fussiness, or lethargy, and thrush (oral candidiasis) 3
• Standard clinical practice includes antibiotics when there are clear signs of infection, and amoxicillin-clavulanate provides adequate coverage against common pathogens in bacterial mastitis, as recommended by the American Academy of Pediatrics 6

Management of Breastfeeding During Antibiotic Treatment

• It is essential to continue breastfeeding during treatment and combine antibiotic therapy with frequent and complete emptying of the affected breast, as recommended by the American Academy of Pediatrics 6
• Choosing antibiotics with shorter half-lives can help minimize accumulation in breast milk, as supported by the recommendations for various antibiotics, according to the American Academy of Dermatology 1, 2