Admissible antibiotics for lactation

Are there safe antibiotics for lactation? How correctly to take such drugs and what is the risk of their use for mom and child?

Medicinal products of synthetic or organic origin are antibiotics. For the first time they were used in the early twentieth century, and have experienced many transformations over the past decade. To date, there are more than 100 types of antibacterial drugs, which are divided into 11 pharmacotherapeutic groups.

The mechanism of action of antibiotics is aimed at suppressing or destroying pathogens. But universal medicines that are equally effective for different bacteria do not exist. During lactation, the female immune system works at full speed, but even this can not prevent infectious infection and the development of the inflammatory process.

Antibiotics used in the lactation period are characterized by a certain effect on the child's body:

• In breast milk, about 10% of the dose is absorbed. Despite such a minimal amount, most pediatricians do not recommend the use of medication during lactation.
• The maximum safe treatment regimen can be chosen only by a doctor, individually for each patient. The dosage and duration of the course depend on the pharmacokinetics of the active components, that is, absorption, distribution and excretion. Given all these nuances, some medicines can be combined with breastfeeding.
• Antibiotics allowed for lactation are included in category A-C. This classifier was developed by the FDA (American Federal Food Commission). The first group includes the most harmless drugs, the studies of which were carried out both in animals and in humans and showed a positive effect. Medicines from the second and third group, tested only in animals, that is, their safety in humans has not been tested.

The nursing mother should take into account the characteristics of each prescribed drug in order to minimize the risk of adverse reactions in the child. It is also necessary to carefully study the medication instructions. Since safe antibacterial agents have a permit for use in the annotation.

What are the possible antibiotics for lactation?

There are several groups of drugs that can be used to treat and prevent various diseases in lactating women. Let us consider in more detail what antibiotics can be used for lactation:

1. Group A - studies conducted on animals, did not reveal a negative effect on the baby finding in the womb and receiving breast milk with the drug. Such controlled experiments on a pregnant woman were not conducted.
2. Group B-C - the mechanism of action of drugs was studied only in animals. No adverse effects were detected. The beneficial effect of the drug fully justifies the possible risk of adverse reactions and complications.

Based on the above classification, antibiotics are distinguished, the use of which is allowed for lactating women.

• Penicillins are the first antimicrobial agents invented by man. This group includes a lot of medicines that are allowed both for lactation and for treating children from the first days of their life. Getting into the body, penicillin suppresses the pathogenic flora. The amount of penetration into breast milk is about 0.095% of the accepted dose. The risk of developing side effects is extremely small, but if they develop, it is most often in the form of allergic reactions and short-term diarrhea. Of this group, most commonly prescribed: Ampicillin, Oxacillin, Ticarcillin, Piperacillin, Amoxicillin.
• Cephalosporins are medicines of a new generation with minimal penetration into breast milk. Non-toxic, they can provoke a dysbacteriosis in a child. Causes a decrease in the production of vitamin K, which is involved in the process of hematopoiesis and assimilation of calcium. Most often appoint: Cefuroxime, Ceftibuten, Cefazolin, Cephrioxone, Cefepime.
• Macrolides - are prescribed for allergic reactions to the previous groups. According to the FDA scale, they belong to group C, that is, the third category. Are applied taking into account all potential risks for mother and the kid. Erythromycin, Clarithromycin, Azithromycin, Spiramycin, Midekamycin.

In addition to the above drugs, other medicines can be used in international practice. For example, in the US, drugs from the pharmacotherapeutic group of fluoroquinolones are considered absolutely safe for lactation. While in the UK this group, and especially fluoroquinolone Ofloxacin is banned. Since it is established that the drug has a negative effect on the growth of the child and the condition of the interarticulate cartilage.

The use of each medication should be dictated by the severity of the disease. If lactation is treated with severe infections, for example, sepsis or meningitis, then without contraindications for breastfeeding antibiotics can not be avoided. Such antimicrobials include:

• Aminoglycosides - have a low penetrating ability. But even their small concentrations can affect the baby's kidneys. This group of drugs has a toxic effect on the optic nerves, hearing organs and vestibular apparatus. Medicines from this group: Streptomycin, Kanamycin, Gentamicin, Netilmicin, Amikacin.
• Sulfonamides - aggressively affect the liver of a child, can trigger the development of nuclear jaundice and other toxic lesions. This group includes: Sulfacil-sodium, Etazol, Biseptol, Streptocide, Sulfadimezin, Ftalazol.
• Fluoroquinolones - this group has a controversial clinical study. In some countries, fluoroquinolones are prohibited when lactating. In the United States, only Ofloxacin is available. This category includes: Ciprofloxacin, Norfloxacin, Levofloxacin, Moxifloxacin.
• Lincosamides - their ingestion into breast milk adversely affects the work of the baby's intestines. Popular drugs from this group: Lincomycin, Clindamycin.
• Tetracyclines are another controversial antibiotic that requires a balanced approach to prescribing. Has a toxic effect on the mother's body, and the child causes bone disorders and worsens the state of tooth enamel. Tetracycline, Doxycycline.

Correctly selected course of antibiotic therapy can be determined only by the attending physician. It is contraindicated to take any medicines independently during lactation.

List of approved antibiotics for lactation

Drugs used during breastfeeding, are divided into several groups. Each of the pharmacological categories has a certain effect on the children's body, getting into it with the mother's milk. Let's consider the list of allowed antibiotics for lactation and the peculiarities of their effects on the body, both mother and child.

1. Penicillins - penetrate into breast milk, can provoke a baby's bowel disorder, allergic rashes.
2. Cephalosporins - when ingested in breast milk, cause the same reactions as penicillins.
3. Macrolides - penetrate the milk, but do not have a negative effect on the children's body.
4. Aminoglycosides - in a small amount penetrate into breast milk and cause intestinal disorders.
5. Glycopeptides - get into the mother's milk and provoke reactions of the child's hypersensitivity to external stimuli and disorders of the gastrointestinal tract.
6. Monobactams - in a small amount penetrate the children's body, so they must be used with extreme caution.
7. Tetracyclines - cause irreversible changes in the development of rudiments of the teeth and skeleton in children, provoke disorders in the work of the intestine, photosensitivity and candidiasis. Contraindicated during lactation.
8. Fluoroquinolones / Quinolones - provoke violations of varying severity. Most often cause problems in the functioning of joints and growth retardation.
9. Lincosamides - cause disruption in the intestine and increased sensitivity to external stimuli.
10. Sulfonamides - enter the body of a child during lactation, can cause nuclear jaundice and brain dysfunction.

Effects of antibiotics from the groups Oxazolidinones, Nitroimidazoles, Nitrofurans, Polymyxins, Carbapenems have not been studied in the body of infants. The use of these drugs is not recommended during lactation.

An indication that an antibacterial agent can be used during breastfeeding is considered to be its low level of penetration into milk. Another important indicator is the rapid removal of the medicine from the female body. Also, do not forget about the absence of toxic substances that can adversely affect both mother and child.

Modern medicine does not give an unambiguous answer about which antibiotic is safe for lactation. In each case, it is necessary to weigh all the risks, assessing the condition of the mother and the baby, the individual characteristics of their organisms. On this basis, only a doctor can choose an effective and safe treatment regimen.

Indications of the antibiotics for lactation

Antibiotics, like any other drugs, have specific indications for use. The need for their use is most often associated with inflammatory processes. Many of them can be caused by staphylococcal, streptococcal or other harmful microorganisms. Antibacterial drugs for lactation appoint in such cases:

• Infectious-inflammatory lesions of the respiratory tract and lungs.
• Pathology from the birth canal due to a complicated birth process.
• Intestinal infections.
• Mastitis.
• Kidney diseases.
• Diseases of the genitourinary system.

Taking medication ensures normalization of the patient's well-being and accelerates the healing process. In this case, the active substances of medicines penetrate into breast milk, so they can affect the baby's body. On this basis, all drugs during lactation should be prescribed only by a doctor. Since only a doctor can assess the real threat to the baby and the potential benefit to the mother's body.

[1],

Release form

Antibiotics, allowed during lactation, have different types. The form of the release and its choice depend on the severity of the disease, the doctor's recommendations and the ease of use. For the treatment of angina, bronchitis or sinusitis most often use such forms of antibacterial drugs:

• Oral - pills, capsules, syrups, solutions, drops. The only drawback of this form of release is that some drugs (penicillin, aminoglycosides) are poorly absorbed and destroyed, getting into the acidic GIT environment.
• For intramuscular and intravenous administration, these are ampoules with injections and powders for the preparation of a solution for injections. They are used parenterally and for introduction into the internal environment of the body.

In addition to the above forms, antibiotics can be administered in the form of drops, ointments, gel or suppository for rectal / vaginal administration. Regardless of the form of release, after taking, the drug enters the bloodstream and gradually penetrates into the affected organs, providing a therapeutic effect.

[2], [3]

Pharmacodynamics

The reaction of the body and affected tissues, organs to the injected drug is pharmacodynamics. It is characterized by the interaction of an antibiotic with harmful microorganisms to achieve biological activity of a certain degree of severity. In this case, strength, that is, the medicinal properties of drugs, are determined by such factors:

• Dose and dosage form.
• Composition of the drug and its active components.
• Integrity of the antibiotic in the focus of infection.

Consider the pharmacodynamics of antibiotics, which are most commonly used in the period of breastfeeding:

1. Penicillins.

• Penetrate into breast milk, but in an insignificant amount - less than 0.1%. According to the classification, FDA belong to group B (conducted clinical studies did not reveal adverse effects on the child's body).
• Appointed in the case when the benefits for the mother are higher than the possible risks for the child. Very rarely cause adverse reactions, which are manifested by minor rashes on the skin, abnormalities on the part of the gastrointestinal tract.
• Before using this group of drugs, you should consult a pediatrician. Since the child may be prescribed probiotics or antiallergenic agents.

2. Cephalosporins, monobactams, carbapenems.

• They are allowed for breastfeeding and are similar in structure to penicillins. According to the FDA classification, they are part of group B. They have strong antibacterial properties, especially the drugs of the latest generation.
• They have low toxicity and practically do not penetrate into breast milk. Due to this, the risk of developing adverse reactions in the child is minimal. Adverse symptoms are similar to reactions from penicillins.

3. Macrolides, lincosamides.

Penetrate into breast milk by high concentrations, but do not have a negative effect on the baby. In rare cases, cause allergic reactions and intestinal disorders.

4. Aminoglycosides.

Ophthalmic forms of the drug are included in group B according to the FDA, and all the rest belong to category D. Dangerous during lactation, as they have high nephrotoxic and otoxic properties. They can cause the development of complications such as deafness and kidney failure.

[4], [5], [6], [7], [8]

Pharmacokinetics

The methods of ingestion, distribution, metabolism and excretion of medicinal components from the body are pharmacokinetics. The duration of each phase determines the effectiveness of the antibacterial agent and any other drug.

Many antibiotics are distributed among most organs, tissues and biological fluids. Active components accumulate in the respiratory and urinary system, intestinal mucosa, bone system. The degree of penetration into breast milk is less than 1%.

The half-life of antibiotics takes from 1 to 55 hours. This must be taken into account during breastfeeding. Since most drugs are destroyed in the acidic environment of gastric juice, injecting release forms are often prescribed to achieve a persistent therapeutic effect.

[9], [10], [11], [12]

Dosing and administration

The severity of the underlying disease depends on the method of application and the dose of antibiotics for lactation. Use medicines only for medical purposes, adhering to such rules:

• Antibiotic is better to take at the time of lactation or after it. Due to this, the number of active components of the drug that are trapped in breast milk will be significantly less. Multiplicity of medication should be compared with the time of feeding the child.
• If the drug should be taken once a day, it is better to do it before the evening feeding. If the medicine is prescribed 2 times a day, then the first time it is taken before bedtime, and the second after 12 hours, that is, in the evening or at night.
• If breastfeeding has been suspended, then you should continue to express milk every 3-4 hours. In this case, before starting therapy, you need to make a supply of breast milk. It can be stored in the freezer for a month.
• Restorative breastfeeding should be 3-4 days after the end of antibiotic therapy.

During therapy, it is not allowed to change the dosage or treatment regimen that are prescribed by the doctor. This will reduce its effectiveness, which can lead to complications of the disease and will require additional treatment.

[17], [18], [19]

Antibiotics for angina during lactation

Angina is an acute bacterial disease with a defeat of the tonsils. Most often occurs due to streptococcal infection, viruses, fungi, bacteria. Antibiotics for angina during lactation are needed not only to treat the disease, but also to prevent its serious complications. Therapy is performed after consultation with a doctor, as only an expert can make the correct diagnosis and choose safe, but effective drugs.

If acute tonsillitis occurs in mild or moderate form, then antibacterial agents use Amoxiclav tablets. If penicillin intolerances are prescribed, Erythromycin, Azithromycin or Wilprafen. If the pathology proceeds in severe form, then injecting antibiotics are prescribed.

Effective antibiotics for angina during lactation:

1. Amoxiclav

Antibacterial combination. Contains two active components: amoxicillin and clavulanic acid. The first is a broad-spectrum antibiotic, and the second is an inhibitor of beta-lactamase microorganisms. The drug is active against many harmful microorganisms, viruses and bacteria.

• Indications for use: pneumonia, acute and chronic sinusitis, bronchitis, urinary tract infections, otitis media, zaglugal abscess, gynecological infections and soft tissue lesions, gonorrhea, periodontitis and odontogenic infections, prevention of purulent-septic complications, mixed infections.
• There are several forms of production of tablets for oral administration of 250-500 mg amoxicillin / 125 mg clavulanic acid with enteric coating, powder for suspension for oral administration, powder for solution for parenteral administration. Tablets are taken before meals, washed down with water, the dose is selected individually for each patient. The course of treatment is 5-14 days.
• Side effects are mild and temporary. Most often, patients encounter such reactions: nausea, diarrhea, indigestion, vomiting, flatulence, a change in the color of urine. Also, allergic reactions, dizziness and headaches, hepatobiliary disorders, disorders of the urinary system are possible.
• Contraindications: hepatitis, individual intolerance to the components of the drug, cholestatic jaundice. In case of an overdose, there is insomnia, dizziness, increased agitation, convulsions. Treatment is symptomatic, it is possible to conduct hemodialysis.

2. Ampicillin

Semisynthetic antibiotic, is active against gram-positive microorganisms and a number of gram-negative microorganisms. Does not degrade in the acidic environment of the stomach. Effective in diseases caused by a mixed infection.

• Indications for use: pneumonia, bronchopneumonia, lung abscess, tonsillitis, peritonitis, cholecystitis, sepsis, intestinal infections, gonorrhea, soft tissue injuries and other infections caused by microorganisms that are sensitive to the drug.
• Method of use: the preparation is available in the form of oral tablets and powder for the preparation of a suspension. Single dose 500 mg, daily 2-3 g. The daily dosage is divided into 3-6 receptions. The duration of therapy depends on the severity of the disease, usually 5-10 days, but not more than 2-3 weeks.
• Side effects: allergic rashes, disorders of the gastrointestinal tract. To eliminate them, you must stop taking the drug and conduct desensitizing therapy.
• Contraindications: penicillin intolerance, hepatic insufficiency, allergic diseases, bronchial asthma, hay fever.

3. Cefadroxil

Semisynthetic antibiotic cephalosporin series, available in the form of capsules. Has bactericidal properties, is active against a wide range of harmful microorganisms.

• Indications for use: lower respiratory tract infections, bronchitis, pneumonia, urinary tract infections, soft tissues, bones and joints, otitis media, sinusitis, pharyngitis, tonsillitis.
• Usage and dose: capsules are taken orally, regardless of food, with water. Dosage of 1-2 grams per day, divided into several doses. Duration of therapy is 7-10 days.
• Side effect: disorders of the gastrointestinal tract, nausea, vomiting, diarrhea, allergic skin rashes, headaches and dizziness, insomnia, growth of opportunistic microorganisms.
• Contraindications: hypersensitivity to active components. With extreme caution used during pregnancy and lactation.
• Overdose: nausea, vomiting, headaches and dizziness, loss of consciousness. For treatment, gastric lavage and hemodialysis are indicated. During treatment, it is necessary to express milk and not use it. Restore lactation can be 2 days after the end of therapy.

4. Cefazolin

The drug with a wide range of bactericidal effects. It is active against gram-positive and gram-negative microorganisms. It is available in powder form for the preparation of injection solutions.

• Indications for use: pneumonia, lung abscesses, pleural empyema, urinary tract infections, bone and articular infections, skin and soft tissue infections, peritonitis and other diseases caused by microorganisms that are sensitive to the drug.
• Method of administration: the drug is administered intravenously and intramuscularly. Dosage and duration of treatment is determined by the attending physician, individually for each patient. The daily dosage should not exceed 1-4 g.
• Side effects: skin allergic reactions, transient increase in the level of aminotransferase liver. Disorders of the gastrointestinal tract, dysbacteriosis, superinfection, local reactions due to intramuscular injection, phlebitis with intravenous administration.
• Contraindications: intolerance of the components of the drug, pregnancy, newborn children.
• Overdose: dizziness, headaches, paresthesia, convulsions, vomiting, heart palpitations. For treatment symptomatic therapy, hemodialysis is indicated.

5. Erythromycin

Antimicrobial drug, which in the spectrum of its action is similar to penicillins. It is active against gram-positive and gram-negative pathogens. Produced in the form of tablets of 100-250 mg with enteric coating and ointment 1%.

• Indications for use: pneumonia, pneumoplethritis, infectious lung lesions, septic conditions, erysipelas, mastitis, osteomyelitis, peritonitis, purulent inflammatory processes, sepsis.
• Method of administration: a single dosage is 250 mg, in especially severe cases, 500 mg are prescribed. The medication is taken every 4-6 hours 1-1.5 hours before meals. With prolonged use of the drug may develop resistance to it.
• Side effects: nausea, vomiting, diarrhea, impaired liver function, allergic reactions.
• Contraindications: intolerance of active components, severe violations of liver function, allergic reactions in history.

According to the instructions, the antibiotics described above are not recommended for lactation. But it is necessary to take into account that this contraindication is not absolute. The doctor takes into account the state of the mother and child, the course of the disease. Based on this, the dosage and duration of treatment are selected. The course of therapy, as a rule, takes 7-14 days. If necessary, its duration can be extended. It is forbidden to stop taking prescribed medications on your own, as it often leads to serious complications and even death.

Local treatment of angina is ineffective. Since rinsing solutions, compresses or lozenges for resorption do not create the necessary concentration of active ingredients for the destruction of pathogens. Such procedures can be used as a supplement to the main therapy.

Aids for the treatment of acute tonsillitis during breastfeeding:

• Rinsing - it is necessary to carry out when the first symptoms of the disease appear. Allow to prevent the development of purulent complications. From pharmacy drugs, nursing mothers are allowed to take a solution of furacilin, tincture of calendula and eucalyptus, Miramistin, Chlorhexidine, Iodinol. Also for rinses you can use infusion of chamomile and sage, infusion of garlic, aloe juice with Kalanchoe and honey, carrot or beet juice.

• Tablets for absorption, sprays, inhalations - before using them, it is necessary to rinse the throat well so that the infection does not enter the digestive tract. Inhalations can be done with mineral water or saline. From pastilles and tablets for resorption with antiseptics are recommended: Sepptelet, Lizobakt, Strpsils, Trachisan. Also allowed to use spray Stopanguin, Cameton, solutions of sea salt Solin or Aquamaris.

During the treatment of tonsillitis it is very important to monitor the child's condition. Despite the relative safety of the main antibacterial drugs, their use can provoke a baby's digestive disorders, abdominal pain and colic, anxiety, various allergic rashes on the body. If these symptoms occur, you should see a doctor. Since abolition of antibiotics is not recommended, the doctor may prescribe other drugs or temporarily stop lactation.

[20], [21], [22], [23]

Antibiotics for bronchitis in lactation

Inflammation of the bronchial walls caused by viral, bacterial or fungal infections is bronchitis. Infection occurs both contact and airborne. Antibiotics for bronchitis in lactation are necessary to effectively eliminate pathogens and to prevent possible complications. The female organism after weaning is weakened, so it is more susceptible to various infections.

Bronchitis can occur in acute and chronic form. The first lasts about 10 days, accompanied by symptoms of flu or colds. Treatment depends on the causative agent of the disease:

• If a viral infection is detected, then antiviral agents are used. Most often I designate interferon inducers, which stimulate the production of proteins that suppress the growth and development of viruses.
• In bronchitis of bacterial nature, antibacterial drugs are used. The type of medication and its dosage are selected by the attending physician, individually for each patient. In the period of breastfeeding, semisynthetic penicillins, macrolides or cephalosporins are most often used.
• If bronchitis is caused by a fungal infection, then the therapy is based on the use of antifungal drugs. Mandatoryly, expectorants are prescribed to cleanse the bronchi.

Antibiotics of a wide spectrum of action are effective in the treatment of all forms of bronchitis. But they are appointed in the event that the blood test reveals signs of bacterial infection, a woman for a few days keeps a high temperature, there was shortness of breath and sputum became abundant.

Most often, patients with bronchitis are prescribed antibiotics:

1. Amoxicillin

Bactericidal antibiotic from the group of semisynthetic penicillins. Has a wide range of action. Acid-resistant, quickly and completely absorbed in the intestines. Available in the form of oral tablets with enteric coating, oral solution and suspension, dry substance for injection.

• Indications for use: bronchitis, pneumonia, pyelonephritis, angina, urethritis, colibenteritis, gonorrhea and other diseases caused by microorganisms sensitive to the drug. Dosage and duration of treatment depend on medical prescriptions.
• Side effects: various allergic reactions, rhinitis, conjunctivitis, joint pain, fever. In rare cases, the development of superinfection is possible. Also, allergic reactions with cephalosporin antibiotics are possible.

2. Wilprafen Solutab

Antibiotic from the group of macrolides, has bacteriostatic properties. Getting into the focus of inflammation, creates high concentrations of the active ingredient, having a bactericidal effect. The drug is available in the form of enteric-coated tablets and oral suspensions.

• Indications for use: upper respiratory tract infection and ENT organs, lower respiratory tract infection, oral cavity infection, scarlet fever, diphtheria, skin and soft tissue infections, genital and urinary tract infection.
• Method of application: 1-2 g in 2-3 divided doses. Duration of treatment is 5-10 days. The use of elevated doses causes overdose symptoms. This is manifested by violations of the gastrointestinal tract: nausea, vomiting, diarrhea.
• Side effects: heartburn, vomiting, dysbiosis, violation of bile flow, skin allergic reactions, dose-dependent hearing disorders, candidiasis.
• Contraindications: hypersensitivity to macrolides, severe liver dysfunction. With extreme caution used during pregnancy and lactation.

3. Spiramycin

Antibiotic macrolide with bacteriostatic properties. Has a wide range of action. It is available in the form of tablets with an enteric coating.

• Indications for use: bronchitis, pharyngitis, atypical pneumonia, osteomyelitis, soft tissue infections, prostatitis, toxoplasmosis, tonsillitis, urethritis, sinusitis, gynecological pathologies, otitis, prevention of infectious diseases of ENT organs, urinary tract and meningococcal infection. The drug is taken 1 tablet 3 times a day. Duration of treatment is 5-7 days.
• Side effects: skin allergic reactions, itching, diarrhea, nausea, epigastric pain, paresthesia, gastrointestinal ulceration, vomiting, pseudomembranous colitis. Overdose manifests similar signs. There is no antidote, therefore symptomatic therapy is indicated.
• Contraindications: allergic reactions to the components of the drug. With extreme caution, it is used during lactation, with liver failure and with obstruction of the biliary tract.

The duration of treatment and dosage of medications prescribed by a doctor depend on the form and stage of the disease. The reaction of the child to the antibiotic is also taken into account. It is contraindicated to take such medications independently.

[24], [25], [26]

What antibiotics can be used for lactation with genyantritis

Sinusitis is an inflammation of the paranasal sinuses. In 75% of cases, the disease develops due to advanced ARVI or rhinitis. According to medical statistics, every tenth defeat of nasal sinuses is caused by untimely appeal to the dentist. During pregnancy and lactation, this problem is particularly relevant, as hormonal changes lead to a disruption of the water-electrolyte balance and exacerbation of problems with the teeth and chronic pathologies of the nasopharynx.

The disease is characterized by such symptoms: severe headaches, thick purulent discharge from the nose, fever, heaviness. What antibiotics can be used for lactation in genyantritis can be determined only by a doctor after a full diagnosis. This is due to the fact that the disease can be caused by a variety of bacterial agents, starting with a hemophilic rod and ending with Staphylococcus aureus. Diagnosis is carried out with a nasal smear and a microbiological laboratory. This will determine the most suitable antibiotic.

Most often, for the treatment of sinusitis, antibacterial drugs are prescribed:

1. Azithromycin

Antibiotic means of a wide spectrum of action. Refers to the macrolide pharmacological group. It is active against gram-positive and gram-negative microorganisms. Produced in the form of tablets, capsules and syrup in a vial for oral use.

• Indications for use: infectious diseases caused by microorganisms sensitive to the preparation, angina, bronchitis, sinusitis, tonsillitis, scarlet fever, pneumonia, skin and soft tissue infections, Lyme disease, urinary tract infections.
• The medicine is taken 1 tablet 2-3 times a day, the course of treatment is 5-7 days.
• Side effects: nausea, diarrhea, abdominal pain, increased activity of hepatic enzymes, skin rashes.
• Contraindications: intolerance to macrolide antibiotics. With special care is prescribed in pregnancy and lactation, allergic reactions in the history, with severe violations of the liver and kidneys.

2. Augmentin

Antibacterial agent of a wide spectrum of action. It is active against aerobic, anaerobic, gram-positive and gram-negative microorganisms. Contains clavulanic acid and amoxicillin. Produced in tablet form, as a syrup, a dry substance for the preparation of a suspension and powder for injection.

• Indications for use: acute and chronic bronchitis, lobar bronchopneumonia, empyema, lung abscesses, urinary tract infections, sepsis, tonsillitis, sinusitis, pharyngitis, peritonitis, pelvic infections, osteomyelitis, postoperative infectious complications.
• Method of use: the dosage and the course of treatment depend on the form of release of the drug and the severity of the course of the disease. Tablets are prescribed 3 times a day for 375 mg (1 capsule), if the infection has a severe course, then the dosage can be doubled.
• Side effects: digestive disorders, skin allergic reactions, headaches and dizziness, liver dysfunction, hyperemia of the mucous membranes. In the case of an overdose, these reactions take a more pronounced character. To eliminate them, you must stop taking the drug, carry out symptomatic therapy and seek medical help.
• Contraindications: hypersensitivity to the components of the drug, allergic reactions in the anamnesis. With special care and only under medical supervision is used during pregnancy and breastfeeding.

3. Cephalexin

Semisynthetic antibiotic from the pharmacotherapeutic group of cephalosporins of the 1st generation. It has bactericidal properties and a wide spectrum of action. Quickly absorbed from the digestive tract, penetrates into all organs, tissues and body fluids. It has several oral forms of release: capsules, tablets, powder for suspension.

• Indications for use: bronchitis, pneumonia, pleurisy, lung abscess, infections of the ENT organs, infectious lesions of the urinary system and skin, osteomyelitis, arthritis. The drug is prescribed in a dosage of 1-4 g, but if the disease is caused by a gram-negative flora, the dose can be increased to 4-6 g. The course of treatment is 7-14 days.
• Side effects: dyspepsia, diarrhea, pseudomembranous colitis, increased weakness, violation of the blood picture, dizziness, various severity allergic reactions.
• Contraindications: individual intolerance to antibiotics penicillin series and cephalosporins. The possibility of cross-allergy is necessarily taken into account.

4. Ceftriaxone

Cephalosporin antibiotic of 3rd generation. Has a bactericidal effect by inhibiting the synthesis of the bacterial cell wall. Has a wide spectrum of antimicrobial action, affects aerobic, anaerobic, gram-positive and gram-negative microorganisms. It is available in powder form for the preparation of injections.

• Indications for use: infections of the ENT organs, upper and lower respiratory tract, skin and soft tissues, infections of the abdominal cavity organs, sepsis and bacterial septicemia, bacterial meningitis and endocarditis, salmonellosis, prevention of postoperative purulent-septic complications.
• Method of administration: The drug is used for intramuscular and intravenous injections. Use only freshly prepared solutions. With intramuscular administration, 500 mg of the drug is dissolved in 2 ml of water, with intravenous in 5 ml of water or 1 ml of solvent. The daily dose of the active ingredient should not exceed 2 mg.
• Side effects: nausea, vomiting, stool disorders, transient increase in hepatic transaminase activity, cholestatic jaundice, skin allergic rash, blood picture disorder, phlebitis, tenderness at the injection site, candidiasis.
• Contraindications: hypersensitivity to the components of the drug, penicillins and other cephalosporins, pregnancy and lactation, hepatic-renal failure.
• Overdosage occurs with prolonged use of the drug or use of increased dosages. It manifests itself as leukopenia, neutropenia, hemolytic anemia and other abnormalities on the part of the blood picture. Treatment is symptomatic.

When choosing medicines, it should be taken into account that most of the effective drugs are contraindicated for lactating women. This is due to the fact that antibiotics penetrate all body structures, including breast milk. Strongly acting drugs can cause abnormalities on the part of the digestive tract in the child, allergic reactions and even fungal lesions of the mucosa.

In addition to tablets, saline solutions for nasal lavage may be prescribed for treatment. Most often use Marimer, Dolphin or Quix. These drugs clear the nose and sinuses from pus and mucus. For treatment, vasoconstrictive drops may be used, but when used, it is very important not to exceed the daily dosage: Nazivin, Galazoline, Tysin.

If prolonged treatment of sinusitis does not lead to positive results, this may indicate the presence of cysts or polyps in the nasal sinus. In particularly severe cases, surgical intervention is possible. ENT conducts a puncture of the maxillary sinus. This procedure takes place in an outpatient setting and does not require the cessation of lactation.

Contraindications

The main contraindications to the use of antibiotics in lactation:

• Allergic reactions.
• Individual intolerance of active components and other components of the drug.
• Hepatic Renal Insufficiency.

In the presence of the above contraindications, it is necessary to stop lactation for the duration of therapy.

[13], [14],

Side effects of the antibiotics for lactation

Antimicrobial agents used to treat breastfeeding women can cause side effects, both in the mother and in the child. Most often, patients face such symptoms:

• Allergic reactions.
• Disorders from the digestive system.
• Dysbacteriosis of the intestine.
• Toxic effect on the liver and hematopoietic system.

To eliminate the above-described reactions, it is necessary to stop lactation and to perform symptomatic therapy for the patient and infants.

[15], [16]

Overdose

Failure to comply with medical recommendations for the use of antimicrobials during breastfeeding can lead to various adverse symptoms. An overdose of antibiotics manifests itself in different ways and depends on which particular drug was used:

• In case of an overdose of penicillins and cephalosporins, nausea, vomiting, and stool disorders appear. With the internal administration of large doses, epileptic seizures may begin.
• Tetracyclines are the most dangerous, both for the mother and the baby. Provoke pain in the epigastrium, nausea, vomiting, skin allergic reactions.
• An overdose of aminoglycosides is not life threatening. If these drugs are used in ophthalmic practice, then they can aggravate the neuromuscular blockade.
• An overdose of fluoroquinolones is manifested by a pathological effect on the cardiovascular system. Renal failure, joint and tendon damage, intoxication can also develop.
• Sulfonamides cause nausea and allergic reactions. In rare cases, there is a disorder of cerebral circulation.

To eliminate painful symptoms, there are certain methods for removing active components from the body. First of all, this is the cleansing of the intestines with the help of enterosorbents. Symptomatic therapy should begin with the appearance of the first signs of an overdose. Particular attention should be paid to maintaining the water and electrolyte balance.

[27], [28], [29]

Interactions with other drugs

The number of antibacterial medicines is increasing every year. Therefore, all possible interactions with other drugs should be carefully monitored by the attending physician. Since the combination of certain drugs can cause a variety of adverse symptoms, both in the mother and in the child.

Main interactions:

• Amoxiclav - inactivates aminoglycosides and potentiates the effect of indirect anticoagulants.
• Ampicillin - injectable forms of the drug is contraindicated to mix in a syringe with other medicines.
• Cefazolin - with simultaneous application with probenecid, there is an increase in the concentration of kefzol in the blood plasma.
• Spiramycin - increases metabolism and reduces the activity of oral contraceptives, anticoagulants, glucocorticosteroids.
• Erythromycin - it is contraindicated to use with lincomycin, theophylline, acetylcysteine.

In complex treatment with the use of several drugs simultaneously, it is necessary to take into account the risk of developing synergistic and antagonistic interactions. This can affect the effectiveness of treatment.

[30], [31], [32], [33]

Storage conditions

Since antibiotics used during lactation may have different forms of release, it is necessary to observe the conditions for their storage. Tablets, capsules and dry powders for oral use should be kept in their original packaging, protected from sunlight and out of the reach of children. Recommended storage temperature is 25 ° C. Injections can be stored at room temperature, ready-made solutions should be used on the day of their preparation.

[34], [35], [36], [37], [38], [39]

Shelf life

Antibacterial drugs have different shelf life, which depends on the form of release of the drug and its composition. Tablets and capsules should be used within 24-36 months from the date of their production. The expiry date of injections and other preparations, including for topical application, is indicated on their packaging. Taking overdue medications is contraindicated.

[40]

How to restore lactation after antibiotics?

Many young mothers who undergo antibiotic treatment are confronted with the question: how to restore lactation after antibiotics. During treatment, it is necessary to take into account the fact that temporary admission is not always an indication for stopping breastfeeding. Even without putting the baby to the breast, lactation can be saved. To do this, you must follow these rules:

• Express milk with the frequency with which the baby takes the breast, preferably every 3-4 hours.
• Express milk at night. This contributes to the production of the hormone prolactin, which supports lactation.
• Use only high-quality breast pumps for expressing.
• Drink plenty of fluids, eat fully and rest.

If antibiotics are prescribed routinely, it is necessary to prepare a stock of milk in advance, freezing it. If this is not done, then because of a break in lactation, the baby will have to be switched to nutritional milk formula. When deciding to stop lactation during treatment, the age of the child should be taken into account. Since for babies up to 6 months, mother's milk is the best food.

Restore lactation immediately after antibiotics can not. It is renewed in 2-4 days. A woman should drink a couple of days intestinal sorbents, such as Pelifepan, Enterosgel or Sorbogel. They contribute to the complete elimination of remnants of drugs from the body, and allow you to resume breastfeeding.

Antibiotics for lactation, taken without medical appointment, can cause side reactions. Painful symptoms affect both mother and child. Correct antibiotic therapy, appointed by the doctor, practically does not cause negative consequences and allows for a full treatment.