Antibiotics during breastfeeding: peculiarities of use

Many women during breastfeeding face the need to treat diseases caused by bacteria or pathogenic microbes. Such diseases include pneumonia, pyelonephritis, mastitis, endometritis, infectious inflammation of the urinary tract, etc. For example, acute cystitis, which often occurs after childbirth, is caused by the gram-negative bacterium Escherichia coli or saprophytic staphylococcus, which can only be overcome by an antibiotic. So there are many situations in which antibiotics have to be used during breastfeeding. The whole question is which ones.

The safety of using antibacterial agents by nursing women is directly related to the degree of penetration of the active substances of the drug into breast milk and the nature of their possible negative impact when they enter the baby's blood. After all, taking antibiotics during breastfeeding not only increases the risk of side effects on the mother's body, but can cause various toxic reactions, as well as biochemical and physiological abnormalities in the child's body.

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Antibiotic treatment during breastfeeding

The instructions for the vast majority of antibiotics contain three types of wording concerning antibiotic treatment during breastfeeding (and pregnancy). The first: "Contraindicated during breastfeeding." The second: "Use of the drug during pregnancy and lactation is possible only if the expected benefit of therapy for the mother outweighs the potential risk of developing a teratogenic effect." The third: "There is no information on the probable teratogenic or mutagenic effect of the drug when taken during pregnancy. The drug can penetrate into breast milk; breastfeeding should be discontinued for the duration of treatment."

In pharmacology, there are several degrees of safety studies of drugs. The first degree is when "reproduction studies in animals have not revealed a risk of adverse effects on the fetus, and adequate and well-controlled studies in pregnant women have not been conducted." The second degree is when "reproduction studies in animals have revealed an adverse effect on the fetus, and adequate and well-controlled studies in pregnant women have not been conducted, but the potential benefit associated with use in pregnant and lactating women may justify its use despite the possible risk."

And at the third degree, “there is evidence of the risk of adverse effects of the drug on the human fetus, obtained from studies or in practice, but the potential benefit associated with its use in pregnant and lactating women may justify its use despite the possible risk.”

It should be noted that antibiotic treatment during breastfeeding has serious negative consequences, including gastrointestinal tract damage (dysbacteriosis), dysfunction of the kidneys and liver, hematopoietic and nervous systems, suppression of the immune system, etc.

Taking antibiotics while breastfeeding

Taking antibiotics while breastfeeding usually involves stopping breastfeeding during the course of treatment. As practice shows, a temporary refusal to breastfeed often results in a disruption of the natural lactation process. And then the baby has to be transferred to artificial feeding with special milk formulas…

The drugs that should never be used for antibiotic treatment during breastfeeding include tetracycline, chloramphenicol, lincomycin, ciprofloxacin, clindamycin and metronidazole. Thus, tetracycline and its generics can cause bone formation disorders in children, which affects the growth of tubular skeletal bones and the formation of tooth rudiments. Levomycetin inhibits the hematopoietic functions of the bone marrow of infants and can lead to cyanosis (blueness of the skin and mucous membranes due to a high content of reduced hemoglobin in the blood) and a decrease in blood pressure. And the use of clindamycin or metronidazole is fraught with a violation of protein metabolism (amyloidosis).

Also, all antibiotics of the fluoroquinolone group, widely used to treat urological infections, in particular, bacterial cystitis, are absolutely contraindicated during breastfeeding. However, in the USA, ofloxacin, a drug of the second generation of fluoroquinolones, was included in the list of safe antibiotics for breastfeeding. But British doctors hold a diametrically opposed opinion and believe that all antibiotics of the fluoroquinolone group (ofoloxacin, ciprolon, cifloxinal, cifrano, levofloxacin, avelox, nolitsin, etc.) are not suitable for women who breastfeed. Fluoroquinolones damage interarticular cartilage and negatively affect the growth of infants. With a single dose of 200 mg ofloxacin by nursing women, its concentration in breast milk is equal to the content in her blood plasma.

Antibiotics compatible with breastfeeding

Antibiotics permitted during breastfeeding include antibacterial drugs of such groups as penicillins, cephalosporins and macrolides. More precisely, the use of these drugs in the therapy of nursing women is "usually not contraindicated"... It is believed that penicillins (penicillin, ampicillin, ampiox, amoxicillin, amoxiclav) and cephalosporins (cefazolin, cephalexin, cefaxitin) enter breast milk in small quantities, and, therefore, are safe for the health of infants.

According to research by the American Academy of Pediatrics, amoxicillin is acceptable for use during breastfeeding: a single dose of 1 g taken by a nursing mother enters milk in an insignificant amount (less than 0.095% of the maternal dose), which does not lead to adverse effects for the child. However, a rash and intestinal microflora disturbance may sometimes occur. Adverse reactions (skin rash, diarrhea, thrush) were noted in 8.3% of children exposed to amoxicillin.

Officially, cephalosporin antibiotics do not cause consequences for infants. But these drugs cause dysbacteriosis and thereby reduce the production of vitamin K in the intestine. And this, in turn, creates a deficiency of the clotting factor prothrombin in the blood (increased risk of bleeding), and also reduces the level of absorption of calcium and vitamin D, which occurs only with the participation of vitamin K.

Macrolides are also considered to be antibiotics compatible with breastfeeding: erythromycin, azithromycin, sumamed, vilprofen, etc. Although the instructions for the same sumamed clearly state: "Sumamed is not prescribed during pregnancy and breastfeeding, except in cases where the benefit of using the drug outweighs the possible risk." According to British pharmacists, antibiotic treatment during breastfeeding is only permissible with erythromycin, and all other drugs from the macrolide group should not be used during pregnancy and lactation. So, as you can see, there is no consensus among experts, and the use of "approved" antibiotics should be approached with the utmost caution.

It is worth mentioning the group of aminoglycoside antibiotics (neomycin, kanamycin, gentamicin, amikacin, etc.) separately. Aminoglycosides are more toxic than all other antibiotics. They are prescribed only in the most severe cases - meningitis, sepsis, peritonitis, abscesses of internal organs. And their side effects are scary to even list, it is enough to name only hearing loss (up to complete deafness), damage to the optic nerve and irreversible vestibular disorders.

Doctors who prescribe antibiotics during breastfeeding are obliged to warn their patients about the possibility of an allergic reaction in the child and other quite probable negative consequences of antibacterial therapy. And in such a case, it is recommended to either stop taking the medication or temporarily stop breastfeeding the child.

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Breastfeeding after antibiotics

If a nursing mother needs antibacterial therapy and the doctor has prescribed antibiotics, then breastfeeding after antibiotics is carried out in the established order, but the intake of the drug is adjusted with the time of feeding. According to experts, it is best to take the prescribed drug before the longest break in feeding - that is, in the evening, before bed. However, specific recommendations (on the scheme and duration of administration, daily and single dosage of the drug) should be given by the doctor.

Breastfeeding after antibiotics that are contraindicated or not recommended during lactation should be resumed only after the drug and all its metabolites (products of biological transformation) have been removed from the tissues and organs of the nursing woman. Each drug, including antibiotics, has its own time period. It is indicated in the instructions for a specific drug (in the "Pharmacokinetics" section).

The less the drug binds to blood plasma proteins, the longer its elimination (removal) will be. There are antibiotics that are eliminated from the body in 40-60 hours, and there are those that remain in the body for 5-7 days after the last dose.

Prescribing medications is the competence of the attending physician. And this is an axiom. However, antibiotics during breastfeeding are still controversial issues in clinical practice in the 21st century. Therefore, in order to avoid sometimes irreversible consequences, one should be especially careful when taking this group of drugs.

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