Antibiotics for lactation

In the period of breastfeeding women are inclined to get sick no less than before or during pregnancy. And at this time, mom needs to think not only about whether a particular antimicrobial drug is suitable for her, but also about how it will affect the health and health of the baby. The greater number of medicines that a nursing woman takes is quickly found in breast milk. How to be? In this article, we will talk about how to take antibiotics in lactation, if there is a need for their admission.

[1], [2], [3], [4],

Whether it is possible antibiotics at a lactemia?

Before appointing a nursing mother an antibiotic, the doctor must answer the following questions:

• Will the drug harm the baby?
• Will the antibiotic treatment affect the production of milk?
• Is it possible to do without antibiotic therapy?
• What drugs to take, and in what dosage to reduce the percentage of penetrating into the milk drug?

Of course, not all antibiotics are suitable for admission during lactation. Therefore, there is no need to speak about antibiotic therapy alone, it is necessary to see a doctor. The doctor will choose the right drug for the woman, which is allowed for breastfeeding. However, the task of the nursing mother is to reduce the risk of transferring the drug to the baby as much as possible.

• Ask your doctor if you really need this remedy, and whether it can not be replaced by another, less toxic.
• Of all the proposed antibiotics, choose one that in a lower concentration falls into the milk. If the doctor advises you to give up feeding, explain to him how much the need for lactation is important for you and for the baby: perhaps there is a way to avoid breaks in feeding.
• In order that the drug, if possible, does not enter the circulatory system, in some cases it is possible to replace antibiotic tablets, for example, on ointments, nasal sprays.
• Remember that antibiotics that are quickly removed from the bloodstream (they need to be taken at least 3 or 4 times a day) are more preferable for lactation than prolonged drugs (which are taken 1-2 times per day).
• Adjust the feeding time for the antibiotic. Ask your doctor, after what time after taking the pill, the maximum concentration of the drug substance in the bloodstream occurs - at this time it is better not to feed.
• If possible, feed the baby before taking the pill. It is also possible before this to express milk and make a reserve for subsequent feeding.
• It is best to take the pill just before the longest sleeping baby, for example, after feeding at night.
• If you doubt that the antibiotic you prescribed is safe, and you can not temporarily give up feeding (for example, the baby is allergic to the mixture), ask the doctor about controlling the content of the drug substance in the milk or in the baby's blood.

Indications for use of antibiotics for lactation

Antibiotics during lactation are prescribed only in extreme cases. For this, there must be a strong indication. For example, there is the following list of diseases in which antibiotic therapy is indicated:

• tonsillopharyngitis;
• erysipelas;
• inflammation of the lungs, sinusitis, exacerbation of chronic bronchitis;
• meningitis, meningococcemia;
• sepsis;
• infective endocarditis;
• intestinal infectious diseases (shigellosis, salmonellosis);
• infectious dermatitis;
• infectious diseases of the oral cavity (periodontitis, periostitis);
• pyelonephritis;
• infectious lesions of the pelvic organs;
• osteomyelitis;
• specific infections.

When lactation is not recommended to use antibiotics without evidence or for preventive purposes. The administration of drugs should be justified.

[5], [6], [7], [8]

Form of issue

The antibiotics allowed in lactation can exist in various medications. The choice of the form is most often determined by the convenience of taking the drug, as well as by minimizing the ingress of curative (antimicrobial) substances into the bloodstream.

Injection - when lactation is often used intramuscular injection of a solution - a liquid medicinal variant, which is obtained by dissolving one or several medications. Such a solution can be used not only directly for injections, but also for external treatment of tissues.

Tablets, with or without a coating, are the most common form of solid dosage form, which is already indicated in appropriate doses. The tablet is a compressed version of one or more medicinal substances.

Ointment is an option for a mild form of medication, usually with a viscous consistency. Used for external applications. To this form are liniments - liquid ointments.

Suppositories are a form of medicine that remains dense at room temperatures and melts at the temperature of a person's body. It is prescribed for insertion into the cavity (usually rectally or vaginally).

Drops - liquid medicinal medicines, consisting of true and colloidal solutions. Dosage is done by the patter.

[9]

Pharmacodynamics

It is characteristic that the more modern the generation of antibiotics, the more they have a wider spectrum of action.

As a rule, antibiotics are active against streptococci, staphylococci, bacilli, enterococci, listeria, corynebacteria, neiseries, spirochetes and other microorganisms.

Some antibiotics, for example, aminoglycosides, are capable of destroying hemophilia, shigella, salmonella, legionella, etc.

In any case, before assigning a drug and proceeding to treatment, it is recommended to conduct a test for the sensitivity of microorganisms to the action of antibiotics. Only in this case, you can safely appoint exactly the drug that will be most effective for treatment and at the same time is safe for the baby who is breastfed.

Pharmacokinetics

Most drugs can be significantly destroyed by the acidic environment of gastric juice. For this reason, often antibiotics are given by injection, or in the form of capsules (with protection against the influence of hydrochloric acid). The most comfortably absorbed in the digestive system is amoxicillin (more than 80%).

As a rule, the bioavailability of drugs depends little on the simultaneous use of food. Exceptions are ampicillin and oxacillin.

Antibiotics can be distributed in most organs, tissues and biological media. Large amounts of active substances are observed in the respiratory organs, urinary system, in the intestinal mucosa, in the organs of the genital sphere, in the bone system. Among the antibiotics allowed for lactation, the percentage of penetration into breast milk is the lowest - less than 1%. The half-life of antibiotics can range from 1 hour to 55 hours, so these data need to be specified, applicable to each specific antimicrobial drug.

Authorized antibiotics for lactation

Antimicrobials that can be combined with breastfeeding are the following medicines:

• Antibiotics of the penicillin group. Natural origin (benzylpenicillin, phenoxymethylpenicillin), semi-synthetic origin (oxacillin, ampicillin, amoxicillin, carbenicillin, ticarcillin, azlocillin, piperacillin, amoxiclav). Admission of such drugs does not cause the formation of high concentrations in milk, but they should be taken with caution, since their use can cause sensitization of babies, the appearance of rashes, fungal infections and diarrhea.
• Group of cephalosporins (ß-lactams). Antibiotics of the first generation (cefazolin, cephalexin, cefadroxil), the second generation (cefuroxime, cefaclor), III generation (cefotaxime, ceftriaxone, ceftazidime, cefoperazone) and IV preparation cefepime. Caution should be exercised when taking cefixime and ceftibutene, as these medicines have not yet passed sufficient clinical tests.
• Group of aminoglycosides. Antimicrobial agents of the first generation (streptomycin, kanamycin), preparations of the second generation (gentamicin, tobramycin, netilmicin), as well as the preparation of the third generation of amikacin. Note that the first generation of aminoglycosides also include neomycin, but its use during lactation is prohibited.
• Macrolide antibiotics. These drugs include erythromycin, clarithromycin, roxithromycin, spiramycin, azithromycin, josamycin and midecamycin. However, among all the listed drugs, only erythromycin is considered safe for the baby, the remaining macrolide antibiotics should be avoided for the lactating woman.

Dosing and Administration

Dosage of drugs to lactating women is determined only by the doctor directly at the reception. Independently use drugs, as well as make adjustments to prescribed treatment plan is not recommended.

Nevertheless, there are some features of the application that you need to know about.

• Antibiotics are taken with a lot of liquid. Oxacillin and ampicillin are taken on an empty stomach, and the remaining drugs - regardless of eating.
• If the drug is taken as a suspension, then it should be prepared and consumed according to the annotation to the drug.
• It is necessary to strictly adhere to the prescribed treatment regimen, not missing the medication. Tablets should preferably be taken at the same time intervals. If the dose was accidentally missed, then it should be taken in the very near future, but if it is already time to take the next dose, then take a double dose of the drug is not needed.
• Carefully read the package: in no case should you use medicines with an expired date of validity, since in this case the toxic effect of the drug may be intensified.
• If there are side effects, you should definitely stop taking the antibiotic and immediately tell the doctor about it.

[13], [14], [15]

Contraindications to the use of antibiotics for lactation

Antibiotics for lactation are not used in the following situations:

• if there is a tendency to allergy to antibiotics in women;
• with the development of unwanted symptoms in the child (violation of intestinal microflora, signs of sensitization, skin rashes, fungal skin lesions, genital organs, mouth);
• with serious violations of the liver and kidneys (in renal and hepatic insufficiency);
• in the presence of fungal diseases in the nursing mother.

When using antibiotics during lactation, it is necessary to closely monitor the condition and well-being of the child in order to notice undesirable symptoms in a timely manner and take appropriate measures.

[10], [11], [12]

Side effects of antibiotics in lactation

Reception of antibiotics during breastfeeding can provoke the appearance of serious side effects:

• disruption of the digestive system (dysbiosis);
• decrease in the protective capacity of the body (immunity);
• disorders of the liver, urinary system, hematopoiesis, neural regulation, etc.

Since the drug, albeit in small amounts, but still penetrates into breast milk, it can cause adverse effects in sensitive children, in the form of sensitization of the child's body. What does this mean?

Sensitization of the child is the appearance of excessive sensitivity of his organism to medicines. That is, using an antibiotic, we can activate the immune system of the child to an excessive susceptibility. As a result, the baby may experience allergies, diathesis and other unpleasant events.

Overdose

When taking too large a dose of the drug, there may be an increase in side effects, worsening of the child's condition, allergic manifestations. The following undesirable symptoms may also occur:

• pain and discomfort in the abdomen, dyspeptic disorders (attacks of nausea, vomiting, diarrhea);
• from the liver - increased activity of transaminases, jaundice;
• pain in the head, dizziness, impaired motor coordination, disorder of auditory functions.

At the first signs of an overdose it is important to consult a doctor. Gastric lavage may be performed, sorbent preparations taken, in severe cases hemodialysis is indicated.

Interactions with other drugs

It is inadmissible to mix penicillins and aminoglycosides preparations into one injection - these solutions are incompatible in their physical and chemical characteristics.

When using benzylpenicillin potassium salt in combination with potassium-sparing diuretics or potassium-containing drugs, hyperkalemia may develop.

Do not combine penicillin preparations with drugs that dilute blood - bleeding may occur.

Anti-acid (antacid) drugs reduce the absorption of certain antibiotics in the digestive tract.

Storage conditions

When buying antibiotics, you must always pay attention to the conditions in which the drug should be stored, as well as on the date of manufacture and the expiry date - such a period, as a rule, is no more than 2 or 3 years. With the expiration of the acceptable shelf life, the effectiveness of the antibiotic may decrease, as well as its toxicity, which is especially undesirable for a nursing woman.

Moreover, antibiotics with lactation with the expired term can provoke side manifestations and unforeseen reactions of the organism, both the mother and her child. Therefore, buy only the right drugs that were stored correctly: if the package says that the antibiotic solution should be stored in the refrigerator, and the pharmacist in the pharmacy gets you medicine from the usual cupboard - refrain from buying such a medicine.